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General NPI Number Information
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NPI Number | 1982754552
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Entity Type | Organization
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Legal Business Name | NUVATION HEALTH SERVICES P.C.
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Dates
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Enumeration Date | 01/12/2007
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Last Update Date | 03/03/2010
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Provider Practice Location Address
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Address Line | 600 SOUTH 2ND ST SUITE 201
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City | BISMARCK
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State | ND
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Zip | 58504-5729
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Country | US
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Telephone | 701-258-3780
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Fax | 701-258-6431
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Provider Business Mailing Address
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Address Line | 600 SOUTH 2ND ST SUITE 201
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City | BISMARCK
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State | ND
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Zip | 58504-5729
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Country | US
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Telephone | 701-258-3780
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Fax | 701-258-6431
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Authorized Official
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Title or Position | PARTNER-AUTHORIZED SIGNATURE
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Name | MS. THERESA ANN PORTER
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Credential | LICSW
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Telephone | 701-391-7968
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 2899
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License Number State | ND
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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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