Provider Demographics
NPI:1497416507
Name:SMITH, TRICHELE (LMSW)
Entity Type:Individual
Prefix:
First Name:TRICHELE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10890 45TH AVE NW # 156
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:ND
Mailing Address - Zip Code:58782-9701
Mailing Address - Country:US
Mailing Address - Phone:701-833-7812
Mailing Address - Fax:
Practice Address - Street 1:1705 4TH AVE NW
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58703-2912
Practice Address - Country:US
Practice Address - Phone:701-839-0474
Practice Address - Fax:701-839-0713
Is Sole Proprietor?:No
Enumeration Date:2022-01-02
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND61861041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical