MICHELLE GAYETTE LAC
Addiction Substance Use Disorder
Bismarck, North Dakota
Provider NPI: 1629014287
Provider Information:MICHELLE GAYETTE LAC
Gender: F
Not Sole Proprietor
Practice Location:
1237 W DIVIDE AVE STE 5 BISMARCK, ND 58501 US
Tel: 701-328-8759 Fax: 701-328-8900
Business Mailing Address:
1237 W DIVIDE AVE STE 5 BISMARCK, ND 58501 US
Tel: 701-328-8759 Fax: 701-328-8900
Entity Type: Individual
Taxonomy:
Primary | Code | Category/Description | State | License Number |
---|---|---|---|---|
Y | 101YA0400X | Behavioral Health & Social Service Providers Counselor Addiction (Substance Use Disorder) | ND | 1445 |
Other Provider Identifiers:
Issuer | Number | State | Type |
---|---|---|---|
BCBS OF ND | 017428 | 01 |
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin