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General NPI Number Information
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NPI Number | 1013513134
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Entity Type | Organization
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Legal Business Name | MISSOURI RIVER HEALTH
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Dates
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Enumeration Date | 12/05/2020
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Last Update Date | 12/05/2020
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Provider Practice Location Address
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Address Line | 425 E AVENUE C
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City | BISMARCK
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State | ND
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Zip | 58501-3942
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Country | US
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Telephone | 701-712-9962
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Fax |
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Provider Business Mailing Address
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Address Line | 425 E AVENUE C
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City | BISMARCK
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State | ND
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Zip | 58501-3942
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Country | US
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Telephone | 701-712-9962
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | CASEY NYHUS
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Credential |
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Telephone | 701-527-4806
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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