CANDIS M MOCK LAC

Addiction Substance Use Disorder

Minot, North Dakota

Provider NPI: 1922043546

Provider Information:
 CANDIS M MOCK LAC
Gender: F
Not Sole Proprietor

Practice Location:
1015 S BROADWAY STE 18  MINOT, ND 58701 US
Tel: 701-857-8500  Fax: 701-857-8555

Business Mailing Address:
1015 S BROADWAY STE 18  MINOT, ND 58701 US
Tel: 701-857-8500  Fax: 701-857-8555

Entity Type: Individual

Taxonomy:

Primary	Code	Category/Description	State	License Number
Y	101YA0400X	Behavioral Health & Social Service Providers Counselor Addiction (Substance Use Disorder)	ND	1523

Other Provider Identifiers:

Issuer	Number	State	Type
	054517	ND	05
BCBS ND PIN	025431	ND	01

Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin

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