Provider Demographics
NPI:1649740630
Name:SIMBURGER, STEPHANIE MARIE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:MARIE
Last Name:SIMBURGER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:STEPHANIE
Other - Middle Name:MARIE
Other - Last Name:BITZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:1500 14TH ST. W
Mailing Address - Street 2:SUITE 290
Mailing Address - City:WILLISTON
Mailing Address - State:ND
Mailing Address - Zip Code:58801
Mailing Address - Country:US
Mailing Address - Phone:701-334-6242
Mailing Address - Fax:
Practice Address - Street 1:3111 EAST BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501
Practice Address - Country:US
Practice Address - Phone:701-334-6242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-03
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND46161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical