Provider Demographics
NPI:1316557242
Name:THULL, AMY
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:THULL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 69TH ST N
Mailing Address - Street 2:
Mailing Address - City:GRANVILLE
Mailing Address - State:ND
Mailing Address - Zip Code:58741-9530
Mailing Address - Country:US
Mailing Address - Phone:701-626-2702
Mailing Address - Fax:
Practice Address - Street 1:407 3RD ST SE
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-4470
Practice Address - Country:US
Practice Address - Phone:701-857-2481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-05
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1758101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)