Individual provider Active NPI

Tiram Gamliel, LPCC

  • Professional Counselor
  • Grand Forks, ND
National Provider Identifier
1104882935
Registry record updated Sep 6, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
168-11-15-01-148 Issued in ND
Practice address
3535 S 31St St Ste 201
Grand Forks, ND 58201-3593
Phone
(701) 780-6821
Fax
(701) 780-1973
NPI assigned
Apr 21, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 6, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 00053 MN
Professional Counselor 101YP2500X 168-11-15-01-148 ND Primary

Addresses

Primary practice location

3535 S 31St St Ste 201
Grand Forks, ND 58201-3593

Mailing address

3535 S 31St St Ste 201
Grand Forks, ND 58201-3593
Phone (701) 780-6821

Other identifiers 3

IdentifierTypeStateIssuer
897903100MedicaidMN
24542OtherNDND BC/BS
319K1GAOtherMNMN BC/BS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ND
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240212003620 ND Practitioner - Mental Health Counselor 7911340492 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
University of North Dakota School of Medicine, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Assessment and Therapy Associates of Grand Forks PLLCGroup PAC ID 9436152626, 17 clinicians

Practice addresses (Care Compare)

3535 S 31St St
Suite 201
Grand Forks, ND 58201-3593
Phone (701) 780-6821

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
00053MNMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Assessment and Therapy Associates of Grand Forks, PLLC CurrentSince Jan 1, 2024 Accepting new patients

Locations

3535 S 31st St
Ste 201
Grand Forks, ND 58201
Phone (701) 780-6821

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1145577600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1536192000000",
    "number": "1104882935",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3535 S 31ST ST STE 201",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582013593",
            "telephone_number": "701-780-6821",
            "fax_number": "701-780-1973"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3535 S 31ST ST STE 201",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582013593",
            "telephone_number": "701-780-6821",
            "fax_number": "701-780-1973"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GAMLIEL",
        "first_name": "TIRAM",
        "name_prefix": "Mr.",
        "credential": "LPCC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-21",
        "last_updated": "2018-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MN",
            "license": "00053",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "ND",
            "license": "168-11-15-01-148",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "897903100",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ND BC/BS",
            "identifier": "24542",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MN BC/BS",
            "identifier": "319K1GA",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Forks, ND

Sources for this page

Verify at the official NPI Registry.