Provider Demographics
NPI:1255921276
Name:TAMI JOLLIE-TROTTIER, PHD, PLLC
Entity type:Organization
Organization Name:TAMI JOLLIE-TROTTIER, PHD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TAMI
Authorized Official - Middle Name:S
Authorized Official - Last Name:JOLLIE--TROTTIER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:701-550-5120
Mailing Address - Street 1:PO BOX 810
Mailing Address - Street 2:
Mailing Address - City:BELCOURT
Mailing Address - State:ND
Mailing Address - Zip Code:58316-0810
Mailing Address - Country:US
Mailing Address - Phone:701-550-5120
Mailing Address - Fax:
Practice Address - Street 1:202 JOYFUL CIRCLE
Practice Address - Street 2:
Practice Address - City:BELCOURT
Practice Address - State:ND
Practice Address - Zip Code:58316-5831
Practice Address - Country:US
Practice Address - Phone:701-550-5120
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-23
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysisGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND14827Medicaid
ND1460514Medicaid