Provider Demographics
NPI:1598255929
Name:FARGO MOORHEAD THERAPY SERVICES, PLLC
Entity Type:Organization
Organization Name:FARGO MOORHEAD THERAPY SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:FRYE
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:701-640-0923
Mailing Address - Street 1:1250 5TH ST N
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58102-2715
Mailing Address - Country:US
Mailing Address - Phone:701-640-0923
Mailing Address - Fax:
Practice Address - Street 1:2419 12TH AVE S STE 2F
Practice Address - Street 2:
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560-3848
Practice Address - Country:US
Practice Address - Phone:701-640-0923
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-10
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty