| Dakota Institute Of Trauma Therapy, Pc | |
|
4023 State St Suite120 Bismarck ND 58503-0690 | |
| (701) 751-4447 | |
| (701) 751-4471 |
| Full Name | Dakota Institute Of Trauma Therapy, Pc |
|---|---|
| Speciality | Social Worker |
| Location | 4023 State St, Bismarck, North Dakota |
| Authorized Official Name and Position | Lynnea Jane Ritz (OWNER) |
| Authorized Official Contact | 7014264398 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dakota Institute Of Trauma Therapy, Pc 4023 State St Suite120 Bismarck ND 58503-0690 Ph: (701) 751-4447 | Dakota Institute Of Trauma Therapy, Pc 4023 State St Suite120 Bismarck ND 58503-0690 Ph: (701) 751-4447 |
| NPI Number | 1114286986 |
|---|---|
| Provider Enumeration Date | 05/14/2012 |
| Last Update Date | 11/11/2013 |
| Medicare PECOS PAC ID | 8527210178 |
|---|---|
| Medicare Enrollment ID | O20121206000383 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114286986 | NPI | - | NPPES |
| 11755287 | Other | CAQH | |
| HP 65336 | Other | HEALTH PARTNERS | |
| 100253255 | Medicaid | NE | |
| 19147 | Medicaid | ND |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 2899 (North Dakota) | Primary |
| Provider Name | Lynnea J Ritz |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1881705465 PECOS PAC ID: 3678500451 Enrollment ID: I20050722000824 |
| Provider Name | Theresa E Magelky |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1508224254 PECOS PAC ID: 8628374089 Enrollment ID: I20160310000975 |
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