Provider Demographics
NPI:1699123117
Name:DAKOTA INSTITUTE OF TRAUMA THERAPY
Entity type:Organization
Organization Name:DAKOTA INSTITUTE OF TRAUMA THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER/BILLING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:DELZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-751-4447
Mailing Address - Street 1:4023 STATE ST # 120
Mailing Address - Street 2:
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 # 120
Practice Address - Street 2:
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:2016-05-25
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1371101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty