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Individual

MR. BRUCE E GILLETTE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
LAC

Contact information

Practice address
300 13TH AVE W STE 1, DICKINSON, ND 58601-4875
(701) 227-7580
(701) 227-7575
Mailing address
300 13TH AVE W STE 1, DICKINSON, ND 58601-4875
(701) 227-7580
(701) 227-7575

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1378
ND

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
54523
ND
Enumeration date
05/19/2008
Last updated
11/28/2008
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