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General NPI Number Information
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NPI Number | 1598255929
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Entity Type | Organization
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Legal Business Name | FARGO MOORHEAD THERAPY SERVICES, PLLC
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Dates
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Enumeration Date | 05/10/2018
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Last Update Date | 05/10/2018
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Provider Practice Location Address
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Address Line | 2419 12TH AVE S STE 2F
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City | MOORHEAD
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State | MN
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Zip | 56560-3848
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Country | US
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Telephone | 701-640-0923
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Fax |
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Provider Business Mailing Address
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Address Line | 1250 5TH ST N
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City | FARGO
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State | ND
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Zip | 58102-2715
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Country | US
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Telephone | 701-640-0923
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ELIZABETH FRYE
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Credential | LMFT
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Telephone | 701-640-0923
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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