Provider Demographics
NPI:1902325319
Name:ROLLER PSYCHOLOGY, PLLC
Entity Type:Organization
Organization Name:ROLLER PSYCHOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLEE
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROLLER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:701-792-6488
Mailing Address - Street 1:16771 15TH ST NE
Mailing Address - Street 2:
Mailing Address - City:BUXTON
Mailing Address - State:ND
Mailing Address - Zip Code:58218-9239
Mailing Address - Country:US
Mailing Address - Phone:701-792-6488
Mailing Address - Fax:701-335-7100
Practice Address - Street 1:16771 15TH ST NE
Practice Address - Street 2:
Practice Address - City:BUXTON
Practice Address - State:ND
Practice Address - Zip Code:58218-9239
Practice Address - Country:US
Practice Address - Phone:701-792-6488
Practice Address - Fax:701-335-7100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-18
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND524261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)