NICOLE MARIE JUSTICE (NPI# 1720622822) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1720622822 |
| Entity Type | Individual |
| Full Name | NICOLE MARIE JUSTICE |
| Credential | PHD |
| Practice Address |
2101 Elm St N Fargo ND 58102-2417 |
| Mailing Address |
437 Foxtail Dr West Fargo ND 58078-7964 |
| Practice Telephone | 7012323241 |
| Mailing Telephone | 6127416636 |
| Enumeration Date | 2019-10-31 |
| Last Update Date | 2019-10-31 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103T00000X | Psychologist | 098211 | IA | Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316362825 | Nicole Justice | Speech-Language Pathologist | 4163 Helenrose Ln, Columbus, OH 43230-4059 | 2014-02-20 |
| Street Address |
2101 ELM ST N |
| City | FARGO |
| State | ND |
| Zip Code | 58102-2417 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437143427 | Adam John Glazier | Internal Medicine | 2101 Elm St N, Fargo, ND 58102-2417 | 2005-09-06 |
| 1235740705 | Macy Jane Schindler | Occupational Therapist | 2101 Elm St N, Fargo, ND 58102-2417 | 2020-08-10 |
| 1497363154 | Isaac Nies | Pharmacist | 2101 Elm St N, Fargo, ND 58102-2417 | 2020-07-20 |
| 1376151597 | Paul Afanasi Polanski | Social Worker | 2101 Elm St N, Fargo, ND 58102-2417 | 2020-07-14 |
| 1144848763 | Alexis Kokett | Pharmacist | 2101 Elm St N, Fargo, ND 58102-2417 | 2020-07-09 |
| 1598396459 | Leah Roethel | Dietitian, Registered | 2101 Elm St N, Fargo, ND 58102-2417 | 2020-01-30 |
| 1619508678 | Allison Wanner | Dietitian, Registered | 2101 Elm St N, Fargo, ND 58102-2417 | 2020-01-29 |
| 1750923033 | Samantha J. Tupy | Psychologist | 2101 Elm St N, Fargo, ND 58102-2417 | 2019-10-08 |
| 1639723232 | Madelyn Provost | Pharmacist | 2101 Elm St N, Fargo, ND 58102-2417 | 2019-07-31 |
| 1366096174 | Emilee Gourde | Pharmacist | 2101 Elm St N, Fargo, ND 58102-2417 | 2019-07-30 |
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| 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 |
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| Taxonomy Code | 103T00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and procedures, for the purpose of preventing or eliminating symptomatic, maladaptive, or undesired behavior and of enhancing interpersonal relationships, work and life adjustment, personal effectiveness, behavioral health, and mental health. The practice of psychology includes, but is not limited to, psychological testing and the evaluation or assessment of personal characteristics, such as intelligence, personality, abilities, interests, aptitudes, and neuropsychological functioning; counseling, psychoanalysis, psychotherapy, hypnosis, biofeedback, and behavior analysis and therapy; diagnosis and treatment of mental and emotional disorder or disability, alcoholism and substance abuse, disorders of habit or conduct, as well as of the psychological aspects of physical illness, accident, injury, or disability; and psycheducational evaluation, therapy, remediation, and consultation. Psychological services may be rendered to individuals, families, groups and the public. |
| Notes: Source: American Psychological Association [1/1/2007: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366067084 | Minela Zornic | Psychologist | 204 24th St S Apt 210, Fargo, ND 58103-1350 | 2020-06-09 |
| 1518240332 | Erica R Hoff | Psychologist | 505 40th St. S., Suite 505a, Fargo, ND 58103 | 2011-09-28 |
| 1538399019 | Kristilynn Cedars | Psychologist | 5225 23rd Ave S Route 4712, Fargo, ND 58122-4712 | 2009-07-20 |
| 1982707543 | David Jerome Hartson | Psychologist | 1517 32nd Ave S, Fargo, ND 58103-5905 | 2006-09-07 |
| 1255449989 | Sara D Quam | Psychologist | 3220 18th St S, Ste 4, Fargo, ND 58104-6564 | 2006-08-25 |
| 1114949773 | Eileen Stone | Psychologist | 1308 23rd St S, Fargo, ND 58103 | 2006-07-24 |
| 1215982319 | Jackson William Lind | Psychologist | 100 4th St. S #302, Fargo, ND 58103 | 2006-05-24 |
| 1386186211 | Katie Nylander | Psychologist | 3401 45th St S, Fargo, ND 58104 | 2016-11-09 |
| 1770930273 | Megan L Spencer | Psychologist | 1702 University Dr S, Fargo, ND 58103-4940 | 2016-05-16 |
| 1508232893 | Jodi Lynn Johnson | Psychologist | 2101 Elm St N, Fargo, ND 58102-2417 | 2015-08-20 |
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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.