| Trauma And Attachment Institute Llc | |
|
314 E Thayer Ave Ste 222 Bismarck ND 58501-4018 | |
| (701) 391-7399 | |
| Not Available |
| Full Name | Trauma And Attachment Institute Llc |
|---|---|
| Speciality | Counselor |
| Location | 314 E Thayer Ave Ste 222, Bismarck, North Dakota |
| Authorized Official Name and Position | Jenise Wilson (COUNSELOR/OWNDER) |
| Authorized Official Contact | 7013917399 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Trauma And Attachment Institute Llc 507 N 27th St Bismarck ND 58501-3115 Ph: () - | Trauma And Attachment Institute Llc 314 E Thayer Ave Ste 222 Bismarck ND 58501-4018 Ph: (701) 391-7399 |
| NPI Number | 1710704929 |
|---|---|
| Provider Enumeration Date | 09/20/2024 |
| Last Update Date | 10/14/2024 |
| Certification Date | 10/14/2024 |
| Medicare PECOS PAC ID | 8426584020 |
|---|---|
| Medicare Enrollment ID | O20241205003440 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710704929 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Jenise D Wilson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1063934230 PECOS PAC ID: 3779923255 Enrollment ID: I20240501001204 |
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