Holli Archuletta, MA
Individual provider Active NPI Professional Counselor · Dickinson, ND
NPI 1265829675 · NPPES record last updated Nov 6, 2023
Key facts
- NPI
- 1265829675
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- 86731516327 (ND)
- Practice address
- 1463 I94 Business Loop E
Dickinson, ND 58601-6434 - Phone
- (701) 227-7500
- Fax
- (701) 227-7575
- NPI assigned
- Apr 23, 2015
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Mental Health Counselor
- Education
- Other, 2008
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Badlands Human Service Center
Practice addresses (Care Compare)
1463 I94 Business Loop E
Dickinson, ND 58601-6434
Phone (701) 227-7500
300 13TH Ave W
Suite 1
Dickinson, ND 58601-4875
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ND
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240224000280 | ND | Practitioner - Mental Health Counselor | 1759726227 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 86731516327 | ND | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Badlands Behavioral Health Clinic | Current |
Accepting new patients | |
| Badlands Behavioral Health Clinic | Past |
Accepting new patients |
Locations
600 E Boulevard Ave
Dept 325
Bismarck, ND 58505
Phone (701) 328-4644
300 13th Ave W
Ste 1
Dickinson, ND 58601
Phone (701) 227-7500
1463 I94 Business Loop E
Dickinson, ND 58601
Phone (701) 227-7500
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Case Manager/Care Coordinator | 171M00000X | |||
| Professional Counselor | 101YP2500X | 86731516327 | ND | Yes |
Addresses
Primary practice location
1463 I94 Business Loop E
Dickinson, ND 58601-6434
Mailing address
1463 I94 Business Loop E
Dickinson, ND 58601-6434
Phone (701) 227-7500
Other practice location 1
26 1st St E Ste 102
Dickinson, ND 58601-5266
Phone (701) 751-0299
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 14504853 | Other | CAQH | |
| 1472298 | Medicaid | ND |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | harchuletta@summitcounselinginc.org | Direct |
Other providers in Dickinson, ND
- Patricia W Anderson
- Rose Anderson
- Suzy Anderson
- Tamala M Anderson
- Katelyn Diane Antonsen
- Ross M Argent
- Crystal Lynn Armbrust
- Thomas F Arnold
- Bukola Arogundade
- Lindsey Marie Ascheman
All providers in Dickinson, ND · Professional Counselor in North Dakota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 6, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.