Provider Demographics
NPI:1497577167
Name:BERENTSON PSYCHOLOGICAL SERVICES, PLLC
Entity type:Organization
Organization Name:BERENTSON PSYCHOLOGICAL SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LEA
Authorized Official - Middle Name:
Authorized Official - Last Name:BERENTSON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:701-471-2360
Mailing Address - Street 1:PO BOX 267
Mailing Address - Street 2:
Mailing Address - City:BOTTINEAU
Mailing Address - State:ND
Mailing Address - Zip Code:58318-0267
Mailing Address - Country:US
Mailing Address - Phone:701-389-7963
Mailing Address - Fax:
Practice Address - Street 1:2321 LAKE LOOP RD
Practice Address - Street 2:
Practice Address - City:BOTTINEAU
Practice Address - State:ND
Practice Address - Zip Code:58318-8234
Practice Address - Country:US
Practice Address - Phone:701-389-7963
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-24
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)