Provider Demographics
NPI:1699859173
Name:LAIDLAW PSYCHOLOGICAL SERVICES, PLC
Entity Type:Organization
Organization Name:LAIDLAW PSYCHOLOGICAL SERVICES, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:LAIDLAW
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:701-780-9700
Mailing Address - Street 1:3301 30TH AVE S STE 101
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-6009
Mailing Address - Country:US
Mailing Address - Phone:701-780-9700
Mailing Address - Fax:701-780-9709
Practice Address - Street 1:3301 30TH AVE S STE 101
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-6009
Practice Address - Country:US
Practice Address - Phone:701-780-9700
Practice Address - Fax:701-780-9709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2014-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND204103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDN711209OtherMEDICARE PART B
ND012274Medicaid
ND012274Medicaid