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General NPI Number Information
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NPI Number | 1427446798
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Entity Type | Organization
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Legal Business Name | POSITIVE PSYCHOLOGICAL INITIATIVES LLC
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Dates
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Enumeration Date | 01/08/2015
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Last Update Date | 10/15/2018
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Provider Practice Location Address
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Address Line | 112 UNIVERSITY DR N STE 300
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City | FARGO
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State | ND
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Zip | 58102
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Country | US
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Telephone | 701-866-3641
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Fax | 701-660-1071
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Provider Business Mailing Address
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Address Line | 112 UNIVERSITY DR N STE 300
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City | FARGO
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State | ND
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Zip | 58102-4661
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Country | US
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Telephone | 701-866-3641
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Fax | 701-660-1071
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JAY PHILLIPPI
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Credential | PHD, LP
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Telephone | 701-866-3641
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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