Provider Demographics
NPI:1538551684
Name:STOREY, NATALEE JADE (LAC)
Entity type:Individual
Prefix:
First Name:NATALEE
Middle Name:JADE
Last Name:STOREY
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:NATALEE
Other - Middle Name:JADE
Other - Last Name:MUSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:101 EAST BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58801
Mailing Address - Country:US
Mailing Address - Phone:701-222-0386
Mailing Address - Fax:701-751-5737
Practice Address - Street 1:101 EAST BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58801
Practice Address - Country:US
Practice Address - Phone:701-222-0386
Practice Address - Fax:701-751-5737
Is Sole Proprietor?:No
Enumeration Date:2015-02-26
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1737101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)