IGNITING YOUR CHANGE (NPI# 1609492016) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1609492016 |
| Entity Type | Organization |
| Organization Name | IGNITING YOUR CHANGE |
| Practice Address |
1222 4th Ave N Apt 318 Fargo ND 58102-4374 |
| Practice Telephone | 7016969075 |
| Mailing Telephone | 7016969075 |
| Enumeration Date | 2020-06-22 |
| Last Update Date | 2020-07-07 |
| Authorized Official Name | JESSICA DECKERT (OWNER) |
| Authorized Official Telephone | 7016969075 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM0801X |
Clinic/Center Specialization: Mental Health (Including Community Mental Health Center) |
Ambulatory Health Care Facilities |
| Street Address |
1222 4TH AVE N APT 318 |
| City | FARGO |
| State | ND |
| Zip Code | 58102-4374 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780285924 | Shelley Dene Townsend-hansen | Dentist | 1017 Broadway N, Fargo, ND 58102 | 2020-11-04 |
| 1275190779 | Anthony Joseph Duncan | Student in an Organized Health Care Education/Training Program | 1919 Elm Streent North, Fargo, ND 58102 | 2019-05-21 |
| 1003472317 | Sadie Marie Nelson | Nurse Practitioner | Sanford Broadway Clinic, 801 North Broadway, Fargo, ND 58102 | 2019-05-13 |
| 1124523576 | Christopher Peroutka | Specialist/Technologist | 1300 17th Ave N, Fargo, ND 58102 | 2018-03-28 |
| 1205331873 | Nathan Koens | Specialist/Technologist | 1300 17th Avenue North, Fargo, ND 58102 | 2018-03-27 |
| 1376063370 | Abby Nicole Fredrickson | Student in an Organized Health Care Education/Training Program | 1919 Elm Street North, Fargo, ND 58102 | 2017-06-21 |
| 1780118331 | Stephanie Melquist | Internal Medicine | Internal Medicine Resident Clinic, 801 N Broadway, Fargo, ND 58102 | 2017-04-19 |
| 1104215623 | Justin Lervik | Social Worker | 211 Elm St. N, 122, Fargo, ND 58102 | 2015-01-21 |
| 1770919441 | Courtney Ann Simanski | Speech-Language Pathologist | 415 4th St. N., Fargo, ND 58102 | 2013-09-25 |
| 1821431206 | Lanell Staroba | Pharmacist | 706 D 38th St, Fargo, ND 58102 | 2013-04-16 |
| Find all providers in zip 58102 | ||||
| Taxonomy Code | 261QM0801X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Mental Health (Including Community Mental Health Center) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316569767 | Goetz Mental Wellness Initiative | Clinic/Center | 3911 20th Ave S, Fargo, ND 58103-4705 | 2020-05-08 |
| 1912551797 | Helm Therapy Services, LLC | Clinic/Center | 1330 Page Dr S Ste 102a, Fargo, ND 58103-3562 | 2019-07-30 |
| 1184278004 | Dr. Kayla Moorer, Psychologist, LLC | Clinic/Center | 1330 Page Dr S Ste 102a, Fargo, ND 58103-3562 | 2019-07-29 |
| 1235799842 | Solace Counseling Pllc | Clinic/Center | 1321 23rd St S Ste D, Fargo, ND 58103-3724 | 2019-06-17 |
| 1336702687 | Altendorf Counseling | Clinic/Center | 1351 Page Dr S Ste 100, Fargo, ND 58103-3536 | 2019-04-22 |
| 1790254191 | Clarion Counseling & Consulting, LLC | Clinic/Center | 417 Main Ave Ste 302, Fargo, ND 58103-1956 | 2018-11-15 |
| 1609362888 | Hansen Hearts Counseling, Pllc | Clinic/Center | 3309 Fiechtner Dr S Ste H, Fargo, ND 58103-2375 | 2018-07-10 |
| 1659807949 | Insight Behavioral Health Partners | Clinic/Center | 4357 13th Ave S Ste 104, Fargo, ND 58103-3381 | 2017-05-04 |
| 1225459027 | Lutheran Social Services of Nd | Clinic/Center | 3911 20th Ave S, Fargo, ND 58107 | 2013-12-20 |
| 1053623926 | Attentive Mind Corporation | Clinic/Center | 2902 University Dr S, Fargo, ND 58103-6053 | 2010-07-08 |
| Find all providers in FARGO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.