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DAVID MICKELSON MS/LAC

Addiction Substance Use Disorder

Bismarck, North Dakota

Provider NPI: 1356387534

Provider Information:
 DAVID  MICKELSON MS/LAC
Gender: M
Not Sole Proprietor

Practice Location:
1237 W DIVIDE AVE STE 5 BISMARCK, ND 58501 US
Tel: 701-328-8881  Fax: 701-328-8900

Business Mailing Address:
1237 W DIVIDE AVE STE 5 BISMARCK, ND 58501 US
Tel: 701-328-8881  Fax: 701-328-8900

Entity Type: Individual

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
Y101YA0400XBehavioral Health & Social Service Providers
Counselor
Addiction (Substance Use Disorder)
ND1506

Other Provider Identifiers:

IssuerNumberStateType
BCBS OF ND02373701
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin







ADDICTION JOBS ND - Page 1



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