Provider Demographics
NPI:1720741788
Name:RIVER TRAILS COUNSELING PLLC
Entity Type:Organization
Organization Name:RIVER TRAILS COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:MANDI
Authorized Official - Middle Name:
Authorized Official - Last Name:TALBACKA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:701-527-3300
Mailing Address - Street 1:1120 COLLEGE DR STE 207
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-1225
Mailing Address - Country:US
Mailing Address - Phone:701-751-3111
Mailing Address - Fax:
Practice Address - Street 1:1120 COLLEGE DR STE 207
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-1225
Practice Address - Country:US
Practice Address - Phone:701-527-3300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-18
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty