Provider Demographics
NPI:1285279224
Name:FOUR ELEMENTS THERAPY PLLC
Entity type:Organization
Organization Name:FOUR ELEMENTS THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAMAR
Authorized Official - Middle Name:T
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:701-205-4533
Mailing Address - Street 1:4342 15TH AVE S STE 206
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-1125
Mailing Address - Country:US
Mailing Address - Phone:218-227-5503
Mailing Address - Fax:218-227-5506
Practice Address - Street 1:4342 15TH AVE S STE 206
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-1125
Practice Address - Country:US
Practice Address - Phone:218-227-5503
Practice Address - Fax:218-227-5506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-14
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty