# NICODEMUS THERAPEUTIC SERVICES PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063113108
- **Authorized official:** MR. TIMOTHY SCOTT STARKS LCSW (THERAPIST)
- **Authorized official phone:** (701) 500-5430

## Contact information

- **Practice address:** 525 31ST AVE SW, MINOT, ND 58701-7036
- **Practice address phone:** (701) 355-6800
- **Mailing address:** 525 31ST AVE SW, MINOT, ND 58701-7036
- **Mailing address phone:** (701) 500-5430

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1041C0700X | Clinical Social Worker | — | NULL | Yes |
| 1041C0700X | Clinical Social Worker | — | — | Yes |

## Other

- **Enumeration date:** 03/15/2023
- **Last updated:** 12/13/2023