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:

Primary	Code	Category/Description	State	License Number
Y	101YA0400X	Behavioral Health & Social Service Providers Counselor Addiction (Substance Use Disorder)	ND	1502

Other Provider Identifiers:

Issuer	Number	State	Type
BCBS PIN	023521	ND	01
	054518	ND	05

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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