Healthcare Provider Details

I. General information

NPI: 1225974587
Provider Name (Legal Business Name): PRAIRIE & PINE THERAPY SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 45TH ST S STE 2
FARGO ND
58104-8953
US

IV. Provider business mailing address

2893 164TH AVE SE
ARGUSVILLE ND
58005-9713
US

V. Phone/Fax

Practice location:
  • Phone: 701-394-5036
  • Fax:
Mailing address:
  • Phone: 218-330-5190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: ALLYSON RUST
Title or Position: THERAPIST/OWNER
Credential: LPCC
Phone: 701-394-5036