MEDICARE: FULL CIRCLE PSYCHOLOGY AFFILIATES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1598337917
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FULL CIRCLE PSYCHOLOGY AFFILIATES, LLC

Provider Business Mailing Address
First Line	:	373 COLLINS RD NE STE 203
Second Line	:
City	:	CEDAR RAPIDS
State	:	IA
Zip	:	52402-3167
Country	:	US
Telephone Number	:	319-214-7511
Fax Number	:	319-214-7512

Provider Business Practice Location Address
First Line	:	373 COLLINS RD NE STE 203
Second Line	:
City	:	CEDAR RAPIDS
State	:	IA
Zip	:	52402-3167
Country	:	US
Telephone Number	:	319-214-7511
Fax Number	:	319-214-7512

Authorized Official
Title or Position	:	PSYCHOLOGIST/OWNER
Name	:	DR. STEPHANIE ANTHONY
Credential	:	ED.S., PH.D., HSP
Telephone Number	:	319-214-7511

Provider Enumeration Date	:	07/14/2021
Last Update Date	:	07/14/2021

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