Provider Demographics
NPI:1629649744
Name:FLICK, STORMIE
Entity Type:Individual
Prefix:
First Name:STORMIE
Middle Name:
Last Name:FLICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:STORMIE
Other - Middle Name:
Other - Last Name:ATKINSON/TREVILLIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 9859
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58106-9859
Mailing Address - Country:US
Mailing Address - Phone:701-451-4900
Mailing Address - Fax:651-925-0057
Practice Address - Street 1:20 1ST ST SW STE 250
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-3851
Practice Address - Country:US
Practice Address - Phone:701-852-3328
Practice Address - Fax:651-925-0057
Is Sole Proprietor?:No
Enumeration Date:2021-07-09
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1140-7-1-21A101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional