1578301248 NPI number — COUNSELING ASSOCIATES OF NE IOWA

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 1578301248 NPI number — COUNSELING ASSOCIATES OF NE IOWA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNSELING ASSOCIATES OF NE IOWA
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:
1578301248
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/19/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
310 DAY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DECORAH
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52101-2217
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
563-419-4024
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
806 COMMERCE DR STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DECORAH
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52101-2363
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
563-387-8028
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/17/2024

Additional Information

Authorized Official

Authorized Official Last Name:
BREVIG
Authorized Official First Name:
NICOLE
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO/FOUNDER
Authorized Official Telephone Number:
563-419-4024

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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