Provider Demographics
NPI:1144670019
Name:BISMARCK PSYCHOLOGICAL ASSOCIATES, PLLC
Entity type:Organization
Organization Name:BISMARCK PSYCHOLOGICAL ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST/CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CLAUDETTE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:RENO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:701-751-4122
Mailing Address - Street 1:107 W. MAIN AVE.
Mailing Address - Street 2:SUITE 225
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501
Mailing Address - Country:US
Mailing Address - Phone:701-751-4122
Mailing Address - Fax:701-751-1728
Practice Address - Street 1:107 W. MAIN AVE.
Practice Address - Street 2:SUITE 225
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501
Practice Address - Country:US
Practice Address - Phone:701-751-4122
Practice Address - Fax:701-751-1728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-21
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty