Active NPI
Clayton Henke
- Peer Specialist
- Fargo, ND
National Provider Identifier
1649074097
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Peer Specialist
- License
- 616
- Practice address
- 921 2ND Ave S
Fargo, ND 58103-1705 - Phone
- (701) 318-8204
- NPI assigned
- Apr 3, 2025
- Sex
- Unspecified or another gender identity
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Peer Specialist | 175T00000X | 616 | ND | Primary |
Addresses
Primary practice location
921 2ND Ave S
Fargo, ND 58103-1705
Mailing address
921 2ND Ave S
Fargo, ND 58103-1705
Phone (701) 318-8204
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Light House Recovery Services | Current | Accepting new patients |
Locations
921 2nd Ave S
Fargo, ND 58103
Phone (701) 318-8204
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community/Behavioral Health Agency
- Fargo, ND
- NPI 1144920828
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1743638400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1743638400000",
"number": "1649074097",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "921 2ND AVE S",
"city": "FARGO",
"state": "ND",
"postal_code": "581031705",
"telephone_number": "701-318-8204"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "921 2ND AVE S",
"city": "FARGO",
"state": "ND",
"postal_code": "581031705",
"telephone_number": "701-318-8204"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HENKE",
"first_name": "CLAYTON",
"sole_proprietor": "YES",
"sex": "X",
"enumeration_date": "2025-04-03",
"last_updated": "2025-04-03",
"certification_date": "2025-04-03",
"status": "A"
},
"taxonomies": [
{
"code": "175T00000X",
"taxonomy_group": "",
"desc": "Peer Specialist",
"state": "ND",
"license": "616",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fargo, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.