=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053127605
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ISABELA JEZEL FRANCISCA BULGAN LAC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/09/2024
-----------------------------------------------------
Last Update Date | 10/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 30 7TH ST W FL 3
-----------------------------------------------------
City | DICKINSON
-----------------------------------------------------
State | ND
-----------------------------------------------------
Zip | 58601-4335
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 701-483-0101
-----------------------------------------------------
Fax | 701-483-0121
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1516 MARILYN WAY
-----------------------------------------------------
City | DICKINSON
-----------------------------------------------------
State | ND
-----------------------------------------------------
Zip | 58601-6767
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | 2007
-----------------------------------------------------
License Number State | ND
-----------------------------------------------------