Healthcare Provider Details

I. General information

NPI: 1508785254
Provider Name (Legal Business Name): ELAIA MENTAL HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 10/13/2026
Certification Date: 10/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 16TH AVE S
FARGO ND
58103-4162
US

IV. Provider business mailing address

1205 16TH AVE S
FARGO ND
58103-4162
US

V. Phone/Fax

Practice location:
  • Phone: 701-660-6572
  • Fax: 701-660-6572
Mailing address:
  • Phone: 701-660-6572
  • Fax: 701-660-6572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ALYSSA SKIPLE
Title or Position: CLINICAL SOCIAL WORKER
Credential: LCSW
Phone: 330-360-5145