Four Elements Therapy Pllc | |
4342 15th Ave S Ste 206 Fargo ND 58103-1125 | |
(218) 227-5503 | |
(218) 227-5506 |
Full Name | Four Elements Therapy Pllc |
---|---|
Speciality | Clinic/Center |
Location | 4342 15th Ave S Ste 206, Fargo, North Dakota |
Authorized Official Name and Position | Lamar T Hill (OWNER) |
Authorized Official Contact | 7012054533 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Four Elements Therapy Pllc 4342 15th Ave S Ste 206 Fargo ND 58103-1125 Ph: (218) 227-5503 | Four Elements Therapy Pllc 4342 15th Ave S Ste 206 Fargo ND 58103-1125 Ph: (218) 227-5503 |
NPI Number | 1285279224 |
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Provider Enumeration Date | 11/14/2019 |
Last Update Date | 06/21/2023 |
Certification Date | 06/21/2023 |
Medicare PECOS PAC ID | 9335560614 |
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Medicare Enrollment ID | O20200522002347 |
Identifier | Type | State | Issuer |
---|---|---|---|
1285279224 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1041C0700X | Social Worker - Clinical | (* (Not Available)) | Secondary |
261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
Provider Name | Lamar Terrell Hill |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1710310917 PECOS PAC ID: 6103184551 Enrollment ID: I20171213001410 |
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