Provider Demographics
NPI:1427377712
Name:AZURE, JERI ANN (PHD)
Entity Type:Individual
Prefix:
First Name:JERI
Middle Name:ANN
Last Name:AZURE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:JERI
Other - Middle Name:ANN
Other - Last Name:PARISIEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1149
Mailing Address - Street 2:
Mailing Address - City:BELCOURT
Mailing Address - State:ND
Mailing Address - Zip Code:58316-1149
Mailing Address - Country:US
Mailing Address - Phone:701-477-0483
Mailing Address - Fax:701-477-0488
Practice Address - Street 1:9775 BIA ROAD 9 FL 2
Practice Address - Street 2:
Practice Address - City:BELCOURT
Practice Address - State:ND
Practice Address - Zip Code:58316-2807
Practice Address - Country:US
Practice Address - Phone:701-477-0483
Practice Address - Fax:701-477-0488
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-26
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND486103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND01063Medicaid
ND350063OtherMEDICARE ID-TYPE UNSPECIFIED