Healthcare Provider Details

I. General information

NPI: 1215626197
Provider Name (Legal Business Name): ITS A PART OF PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2023
Last Update Date: 05/05/2023
Certification Date: 04/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5147 44TH ST SOUTH OFFICE #5
FARGO ND
58104-5810
US

IV. Provider business mailing address

10134 BURGUNDY DR
HORACE ND
58047-9007
US

V. Phone/Fax

Practice location:
  • Phone: 701-369-3181
  • Fax:
Mailing address:
  • Phone: 218-230-4529
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JORDYN A KOSKI
Title or Position: OWNER AND MENTAL HEALTH THERAPIST
Credential: LCSW
Phone: 218-230-4529