Healthcare Provider Details

I. General information

NPI: 1285279224
Provider Name (Legal Business Name): FOUR ELEMENTS THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2019
Last Update Date: 06/21/2023
Certification Date: 06/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4342 15TH AVE S STE 206
FARGO ND
58103-1125
US

IV. Provider business mailing address

4342 15TH AVE S STE 206
FARGO ND
58103-1125
US

V. Phone/Fax

Practice location:
  • Phone: 218-227-5503
  • Fax: 218-227-5506
Mailing address:
  • Phone: 218-227-5503
  • Fax: 218-227-5506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
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: LAMAR T HILL
Title or Position: OWNER
Credential: LCSW
Phone: 701-205-4533