Provider Demographics
NPI:1831844349
Name:MARTINSEN BEHAVIORAL HEALTH PLLC
Entity type:Organization
Organization Name:MARTINSEN BEHAVIORAL HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DELLA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MARTINSEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:701-838-2112
Mailing Address - Street 1:2116 4TH AVE NW STE 100
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58703-2967
Mailing Address - Country:US
Mailing Address - Phone:701-838-2112
Mailing Address - Fax:701-838-2115
Practice Address - Street 1:2116 4TH AVE NW STE 100
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58703-2967
Practice Address - Country:US
Practice Address - Phone:701-838-2112
Practice Address - Fax:701-838-2115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-14
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDN731150OtherMEDICARE
ND1485670Medicaid