Provider Demographics
NPI:1679654305
Name:JOLLIE-TROTTIER, TAMI S (PHD)
Entity Type:Individual
Prefix:DR
First Name:TAMI
Middle Name:S
Last Name:JOLLIE-TROTTIER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1149
Mailing Address - Street 2:SUITE A PO BOX 1149
Mailing Address - City:BELCOURT
Mailing Address - State:ND
Mailing Address - Zip Code:58316-0160
Mailing Address - Country:US
Mailing Address - Phone:701-477-0428
Mailing Address - Fax:701-477-0488
Practice Address - Street 1:1015 HOSPITAL RD
Practice Address - Street 2:SUITE A
Practice Address - City:BELCOURT
Practice Address - State:ND
Practice Address - Zip Code:58316-0160
Practice Address - Country:US
Practice Address - Phone:701-477-0428
Practice Address - Fax:701-477-0488
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND411103TP0814X, 103TP0814X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND14827Medicaid
MN1679654305Medicaid
MN1679654305Medicaid