Provider Demographics
NPI:1215586409
Name:BAKKEN BEHAVIORAL HEALTH ASSOCIATES
Entity Type:Organization
Organization Name:BAKKEN BEHAVIORAL HEALTH ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DANEA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZASTE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:701-770-7768
Mailing Address - Street 1:4914 PRAIRIE LN
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:ND
Mailing Address - Zip Code:58801-9349
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:511 2ND ST W STE B
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801-5907
Practice Address - Country:US
Practice Address - Phone:701-770-7768
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-10
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty