Provider Demographics
NPI:1558842641
Name:ORR, MAT
Entity Type:Individual
Prefix:
First Name:MAT
Middle Name:
Last Name:ORR
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 1:1320 BRAMAN AVE
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-2742
Mailing Address - Country:US
Mailing Address - Phone:701-269-9835
Mailing Address - Fax:605-725-8055
Practice Address - Street 1:1320 BRAMAN AVE
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-2742
Practice Address - Country:US
Practice Address - Phone:701-269-9835
Practice Address - Fax:605-725-8055
Is Sole Proprietor?:No
Enumeration Date:2018-08-27
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
SDLPC20608101YP2500X
ND122981522101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor