Provider Demographics
NPI:1023598083
Name:DEVILS LAKE PSYCHOLOGICAL SERVICES, PLLC
Entity type:Organization
Organization Name:DEVILS LAKE PSYCHOLOGICAL SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:HOFFARTH
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:701-662-8255
Mailing Address - Street 1:218 4TH ST NW STE 1
Mailing Address - Street 2:
Mailing Address - City:DEVILS LAKE
Mailing Address - State:ND
Mailing Address - Zip Code:58301-2930
Mailing Address - Country:US
Mailing Address - Phone:701-662-8255
Mailing Address - Fax:701-662-1739
Practice Address - Street 1:218 4TH ST NW STE 1
Practice Address - Street 2:
Practice Address - City:DEVILS LAKE
Practice Address - State:ND
Practice Address - Zip Code:58301-2930
Practice Address - Country:US
Practice Address - Phone:701-662-8255
Practice Address - Fax:701-662-1739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-20
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty