Provider Demographics
NPI:1720054810
Name:DICKINSON FAMILY COUNSELING CENTER
Entity type:Organization
Organization Name:DICKINSON FAMILY COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:BAER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-483-9720
Mailing Address - Street 1:11 2ND AVE E
Mailing Address - Street 2:SUITE B
Mailing Address - City:DICKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58601-5218
Mailing Address - Country:US
Mailing Address - Phone:701-483-9720
Mailing Address - Fax:701-483-9721
Practice Address - Street 1:11 2ND AVE E
Practice Address - Street 2:SUITE B
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-5218
Practice Address - Country:US
Practice Address - Phone:701-483-9720
Practice Address - Fax:701-483-9721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-27
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND013945Medicaid
ND6783-001OtherBLUE CROSS BLUE SHIELD
ND6783-001OtherBLUE CROSS BLUE SHIELD