| Igniting Your Change | |
|
1128 Westrac Dr S Ste A Fargo ND 58103-8729 | |
| (701) 696-9075 | |
| Not Available |
| Full Name | Igniting Your Change |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 1128 Westrac Dr S Ste A, Fargo, North Dakota |
| Authorized Official Name and Position | Jessica Deckert (OWNER) |
| Authorized Official Contact | 7016969075 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Igniting Your Change 1128 Westrac Dr S Ste A Fargo ND 58103-8729 Ph: (701) 696-9075 | Igniting Your Change 1128 Westrac Dr S Ste A Fargo ND 58103-8729 Ph: (701) 696-9075 |
| NPI Number | 1609492016 |
|---|---|
| Provider Enumeration Date | 06/22/2020 |
| Last Update Date | 02/15/2021 |
| Certification Date | 02/15/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609492016 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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