Igniting Your Change

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

IGNITING YOUR CHANGE

Practice address

1128 Westrac Dr S Ste a
Fargo, ND 58103-8729

Phone

(701) 696-9075

NPI assigned

Jun 22, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jessica Deckert

Title

Owner

Phone

(701) 696-9075

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1592784000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1613347200000",
    "number": "1609492016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1128 WESTRAC DR S STE A",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581038729",
            "telephone_number": "701-696-9075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1128 WESTRAC DR S STE A",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581038729",
            "telephone_number": "701-696-9075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IGNITING YOUR CHANGE",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-22",
        "last_updated": "2021-02-15",
        "certification_date": "2021-02-15",
        "status": "A",
        "authorized_official_last_name": "DECKERT",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "701-696-9075"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Clinic/Center (Including Community Mental Health Center) in Fargo, ND
• Providers in Fargo, ND by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.