Provider Demographics
NPI:1740683242
Name:INSIGHT FORENSIC PSYCHOLOGY LLC
Entity type:Organization
Organization Name:INSIGHT FORENSIC PSYCHOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:TROY
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:ERTELT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:701-730-2033
Mailing Address - Street 1:12 S 3RD ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-4798
Mailing Address - Country:US
Mailing Address - Phone:701-730-2033
Mailing Address - Fax:
Practice Address - Street 1:12 S 3RD ST
Practice Address - Street 2:SUITE 203
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-4798
Practice Address - Country:US
Practice Address - Phone:701-730-2033
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-29
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)