Healthcare Provider Details

I. General information

NPI: 1649049412
Provider Name (Legal Business Name): INNOVA COUNSELING SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2023
Last Update Date: 10/13/2026
Certification Date: 10/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2632 47TH ST S STE 102
FARGO ND
58104-8571
US

IV. Provider business mailing address

2632 47TH ST S STE 102
FARGO ND
58104-8571
US

V. Phone/Fax

Practice location:
  • Phone: 701-893-8068
  • Fax: 701-425-0419
Mailing address:
  • Phone: 701-893-8068
  • Fax: 701-425-0419

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: ALISSA L DECOTEAU
Title or Position: OWNER, LCSW
Credential:
Phone: 701-893-8068