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General NPI Number Information
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NPI Number | 1407568181
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Entity Type | Organization
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Legal Business Name | HEALING CIRCLE PSYCHIATRIC SERVICES PLLC
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Dates
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Enumeration Date | 12/14/2022
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Last Update Date | 01/26/2023
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Provider Practice Location Address
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Address Line | 3220 18TH ST S STE 7
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City | FARGO
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State | ND
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Zip | 58104-6564
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Country | US
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Telephone | 701-550-0193
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Fax |
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Provider Business Mailing Address
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Address Line | 3220 18TH ST S STE 7
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City | FARGO
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State | ND
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Zip | 58104-6564
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Country | US
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Telephone | 701-550-0193
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | DR. ALBERT ALLICK
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Credential | MD
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Telephone | 701-550-0193
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #5
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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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Taxonomy #6
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #10
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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Taxonomy #11
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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Taxonomy #12
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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