| Organization Name: | SPIRIT LAKE TRIBE |
| NPI Number: | 1588865794 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | LINDA F DUCKWITZ (YOUTH SERVICES DIRECTOR) |
| Mailing Address: | 816 3rd Ave N Fort Totten |
| State: | ND US |
| Postal Code: | 583359998 |
| Phone Number: | 7017664236 |
| Fax Number: | 7017664878 |
| NPI Enumeration Date: | 05/29/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 1024 |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | ND |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |