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PHILLIP DELANEY LAC

Addiction Substance Use Disorder

Devils Lake, North Dakota

Provider NPI: 1083658165

Provider Information:
 PHILLIP  DELANEY LAC
Gender: M


Practice Location:
200 HIGHWAY 2 W  DEVILS LAKE, ND 58301 US
Tel: 701-665-2200  Fax: 701-665-2300

Business Mailing Address:
PO BOX 650  DEVILS LAKE, ND 58301 US
Tel: 701-665-2200  Fax: 701-665-2300

Entity Type: Individual

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
Y101YA0400XBehavioral Health & Social Service Providers
Counselor
Addiction (Substance Use Disorder)
ND1502

Other Provider Identifiers:

IssuerNumberStateType
BCBS PIN023521ND01
054518ND05
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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