Individual provider Active NPI

Brennan Dale Atherton, PHD

  • Clinical Psychologist
  • Williston, ND
National Provider Identifier
1215319330
Registry record updated May 5, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
585 Issued in ND
Practice address
1309 11TH St W Apt 208
Williston, ND 58801-4654
Phone
(801) 717-0405
NPI assigned
Jun 25, 2015
Last updated
May 5, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 5, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 585 ND Primary

Addresses

Primary practice location

1309 11TH St W Apt 208
Williston, ND 58801-4654

Mailing address

1309 11TH St W Apt 208
Williston, ND 58801-4654
Phone (801) 717-0405

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
I20200707001484 ND Practitioner - Clinical Psychologist 4981027190 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1309 11TH St W
Apt 208
Williston, ND 58801-4654
Phone (801) 717-0405

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
585NDMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Center for Self-Growth & Renewal, PC CurrentSince Feb 10, 2022 Accepting new patients
Northwest Behavioral Health Clinic CurrentSince Feb 25, 2021 Accepting new patients
Prairie River Therapy and Assessments Clinical CurrentSince Nov 8, 2023 Accepting new patients
Volk Human Services Clinical PastSince Jan 11, 2023 Accepting new patients

Locations

1551 28th Ave S
Ste C
Grand Forks, ND 58201
Phone (701) 746-4400

316 2nd Ave W
Williston, ND 58801
Phone (701) 774-4600

Organizations & group practices 4

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

NPI Registry JSON

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

{
    "created_epoch": "1435190400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1777939200000",
    "number": "1215319330",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1309 11TH ST W APT 208",
            "city": "WILLISTON",
            "state": "ND",
            "postal_code": "588014654",
            "telephone_number": "801-717-0405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1309 11TH ST W APT 208",
            "city": "WILLISTON",
            "state": "ND",
            "postal_code": "588014654",
            "telephone_number": "801-717-0405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ATHERTON",
        "first_name": "BRENNAN",
        "middle_name": "DALE",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-06-25",
        "last_updated": "2026-05-05",
        "certification_date": "2026-05-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "ND",
            "license": "585",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Williston, ND

Sources for this page

Verify at the official NPI Registry.