1215285671 NPI number — MORNINGSIDE COUNSELING SERVICES

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215285671 NPI number — MORNINGSIDE COUNSELING SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MORNINGSIDE COUNSELING SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215285671
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/16/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2004 S SAINT AUBIN ST
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
SIOUX CITY
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
51106-2457
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
712-281-4068
Provider Business Mailing Address Fax Number:
712-274-9507

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2004 S SAINT AUBIN ST
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
SIOUX CITY
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
51106-2457
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
712-281-4068
Provider Business Practice Location Address Fax Number:
712-274-9507
Provider Enumeration Date:
08/16/2012

Additional Information

Authorized Official

Authorized Official Last Name:
CORBETT
Authorized Official First Name:
KEVIN
Authorized Official Middle Name:
CLARK
Authorized Official Title or Position:
SOLE PRACTITIONER
Authorized Official Telephone Number:
712-281-4068

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  1271 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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