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General NPI Number Information
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NPI Number | 1780165415
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Entity Type | Organization
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Legal Business Name | KALEIDOSCOPE BEHAVIORAL HEALTH
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Dates
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Enumeration Date | 08/21/2018
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Last Update Date | 08/21/2018
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Provider Practice Location Address
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Address Line | 511 2ND ST W STE B
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City | WILLISTON
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State | ND
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Zip | 58801-5907
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Country | US
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Telephone | 701-580-0846
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Fax |
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Provider Business Mailing Address
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Address Line | 511 2ND ST W STE B
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City | WILLISTON
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State | ND
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Zip | 58801-5907
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Country | US
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Telephone | 701-580-0846
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | SARAH ANDERSON
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Credential | LICSW
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Telephone | 701-580-0846
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 4168
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License Number State | ND
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