Healthcare Provider Details

I. General information

NPI: 1215586409
Provider Name (Legal Business Name): BAKKEN BEHAVIORAL HEALTH ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2019
Last Update Date: 09/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 2ND ST W STE B
WILLISTON ND
58801-5907
US

IV. Provider business mailing address

4914 PRAIRIE LN
WILLISTON ND
58801-9349
US

V. Phone/Fax

Practice location:
  • Phone: 701-770-7768
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MS. DANEA ZASTE
Title or Position: OWNER
Credential: LCSW
Phone: 701-770-7768