Provider Demographics
NPI:1013096049
Name:NORDAUNE, TINA M (LCSW)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:M
Last Name:NORDAUNE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:
Other - Last Name:SAEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:PO BOX 2354
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:ND
Mailing Address - Zip Code:58802-2354
Mailing Address - Country:US
Mailing Address - Phone:701-774-1122
Mailing Address - Fax:
Practice Address - Street 1:603 MAIN ST
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801-5467
Practice Address - Country:US
Practice Address - Phone:701-774-1122
Practice Address - Fax:701-774-1125
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND3153101YM0800X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND54516Medicaid
NDN6332Medicare ID - Type Unspecified