| Creative Spirit Counseling, Pllc | |
|
4675 40th Avenue South Suite 120 Fargo ND 58104 | |
| (701) 715-8567 | |
| (701) 540-0098 |
| Full Name | Creative Spirit Counseling, Pllc |
|---|---|
| Speciality | Social Worker |
| Location | 4675 40th Avenue South, Fargo, North Dakota |
| Authorized Official Name and Position | Emily M Jones (MANAGING MEMBER) |
| Authorized Official Contact | 7017158567 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Creative Spirit Counseling, Pllc 4675 40th Avenue South Suite 120 Fargo ND 58104 Ph: (701) 715-8567 | Creative Spirit Counseling, Pllc 4675 40th Avenue South Suite 120 Fargo ND 58104 Ph: (701) 715-8567 |
| NPI Number | 1134779176 |
|---|---|
| Provider Enumeration Date | 09/11/2019 |
| Last Update Date | 07/25/2024 |
| Certification Date | 02/15/2021 |
| Medicare PECOS PAC ID | 8527492966 |
|---|---|
| Medicare Enrollment ID | O20191218001439 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134779176 | NPI | - | NPPES |
| 1478422 | Medicaid | ND |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Emily M Jones |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1184142945 PECOS PAC ID: 9436583879 Enrollment ID: I20191218001508 |
| Provider Name | Kaitlyn R Jacobsen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1962043026 PECOS PAC ID: 8022442276 Enrollment ID: I20200117000741 |
| Provider Name | Hannah M. Ritteman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1982048351 PECOS PAC ID: 6901224054 Enrollment ID: I20200922001524 |
| Provider Name | Shannon Pfau |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1023553849 PECOS PAC ID: 6204235377 Enrollment ID: I20210521000331 |
| Provider Name | Lisa M Burger |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1619510617 PECOS PAC ID: 6507235983 Enrollment ID: I20221206002949 |
| Provider Name | Lynae S Hemming |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1598259814 PECOS PAC ID: 5092102905 Enrollment ID: I20240111002639 |
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