Healthcare Provider Details

I. General information

NPI: 1740108802
Provider Name (Legal Business Name): IAN LINN LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2311 45TH ST S STE 4A
FARGO ND
58104-8408
US

IV. Provider business mailing address

2311 45TH ST S STE 4A
FARGO ND
58104-8408
US

V. Phone/Fax

Practice location:
  • Phone: 701-232-1477
  • Fax:
Mailing address:
  • Phone: 701-232-1477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1312-7-15-23-664
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: