Active NPI
Nicole Marie Justice, PHD
- Psychologist
- Fargo, ND
National Provider Identifier
1720622822
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 098211
- Practice address
- 2101 Elm St N
Fargo, ND 58102-2417 - Phone
- (701) 232-3241
- NPI assigned
- Oct 31, 2019
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | 098211 | IA | Primary |
Addresses
Primary practice location
2101 Elm St N
Fargo, ND 58102-2417
Mailing address
437 Foxtail Dr
West Fargo, ND 58078-7964
Phone (612) 741-6636
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 098211 | IA | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1572480000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1572480000000",
"number": "1720622822",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "437 FOXTAIL DR",
"city": "WEST FARGO",
"state": "ND",
"postal_code": "580787964",
"telephone_number": "612-741-6636"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2101 ELM ST N",
"city": "FARGO",
"state": "ND",
"postal_code": "581022417",
"telephone_number": "701-232-3241"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JUSTICE",
"first_name": "NICOLE",
"middle_name": "MARIE",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-10-31",
"last_updated": "2019-10-31",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "IA",
"license": "098211",
"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 Oct 31, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.