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General NPI Number Information
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NPI Number | 1760930929
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Entity Type | Organization
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Legal Business Name | DAKOTA SOUTHWESTERN WELLNESS, P. L.L.C.
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Dates
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Enumeration Date | 09/16/2016
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Last Update Date | 09/16/2016
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Provider Practice Location Address
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Address Line | 606 4TH ST SW
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City | BOWMAN
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State | ND
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Zip | 58623-4527
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Country | US
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Telephone | 701-523-6985
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Fax | 701-279-7185
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Provider Business Mailing Address
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Address Line | PO BOX 475
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City | BOWMAN
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State | ND
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Zip | 58623-0475
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Country | US
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Telephone | 701-279-6981
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Fax | 701-279-7185
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | LINDA KATHRYN WALLER
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Credential | LICSW, DCSW, LAC
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Telephone | 701-279-6981
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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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 #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional 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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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