Provider Demographics
NPI:1972995512
Name:ENDEAVOR CLINIC
Entity Type:Organization
Organization Name:ENDEAVOR CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMMON
Authorized Official - Middle Name:K
Authorized Official - Last Name:FAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:801-603-9880
Mailing Address - Street 1:1045 8TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:BYRON
Mailing Address - State:MN
Mailing Address - Zip Code:55920-1590
Mailing Address - Country:US
Mailing Address - Phone:801-603-9880
Mailing Address - Fax:507-624-0097
Practice Address - Street 1:1045 8TH AVE NW
Practice Address - Street 2:
Practice Address - City:BYRON
Practice Address - State:MN
Practice Address - Zip Code:55920-1590
Practice Address - Country:US
Practice Address - Phone:801-603-9880
Practice Address - Fax:507-624-0097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-18
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty