Healthcare Provider Details

I. General information

NPI: 1265745152
Provider Name (Legal Business Name): PATRICK ERWIN HART LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2010
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 DIVISION AVE STE 101B
GRAND FORKS ND
58201-4702
US

IV. Provider business mailing address

340 DIVISION AVE STE 101B
GRAND FORKS ND
58201-4702
US

V. Phone/Fax

Practice location:
  • Phone: 218-779-0134
  • Fax: 801-894-3059
Mailing address:
  • Phone: 218-779-0134
  • Fax: 801-894-3059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number468869
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number685
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number416266
License Number StateND
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number797-8-1-14
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: