Provider Demographics
NPI:1114286986
Name:DAKOTA INSTITUTE OF TRAUMA THERAPY, PC
Entity type:Organization
Organization Name:DAKOTA INSTITUTE OF TRAUMA THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LYNNEA
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:RITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LICSW
Authorized Official - Phone:701-426-4398
Mailing Address - Street 1:4023 STATE ST
Mailing Address - Street 2:SUITE120
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-0690
Mailing Address - Country:US
Mailing Address - Phone:701-751-4447
Mailing Address - Fax:701-751-4471
Practice Address - Street 1:4023 STATE ST
Practice Address - Street 2:SUITE120
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-0690
Practice Address - Country:US
Practice Address - Phone:701-751-4447
Practice Address - Fax:701-751-4471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-14
Last Update Date:2013-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND28991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
11755287OtherCAQH
HP 65336OtherHEALTH PARTNERS
NE100253255Medicaid
ND19147Medicaid
11755287OtherCAQH
ND711912Medicare UPIN