1891373122 NPI number — SERENITY COUNSELING LLC

Table of content: (NPI 1891373122)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891373122 NPI number — SERENITY COUNSELING LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SERENITY COUNSELING LLC
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:
1891373122
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/22/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 8156
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DES MOINES
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50301-8156
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
641-233-8879
Provider Business Mailing Address Fax Number:
515-462-0504

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3829 71ST ST STE B1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
URBANDALE
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50322-3263
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-954-7811
Provider Business Practice Location Address Fax Number:
515-706-3402
Provider Enumeration Date:
03/30/2021

Additional Information

Authorized Official

Authorized Official Last Name:
WEBSTER
Authorized Official First Name:
SHARAINE
Authorized Official Middle Name:
M
Authorized Official Title or Position:
THERAPIST/ OWNER
Authorized Official Telephone Number:
515-954-7811

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 12398268 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 17002 . This is a "IOWA BOARD OF CERTIFICATION" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 083321 . This is a "IOWA SOCIAL WORK BOARD/ BEHAVIORAL HEALTH" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".




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