MEDICARE: CEDAR RAPIDS COUNSELING & PSYCHOTHERAPY GROUP LLP

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	103T00000X	Psychologist		IA
2	1041C0700X	Clinical Social Worker		IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	36070	OTHER	IA	WELLMARK BCBS

General Provider Information

NPI Number	:	1609824911
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CEDAR RAPIDS COUNSELING & PSYCHOTHERAPY GROUP LLP

Provider Business Mailing Address
First Line	:	118 2ND ST SE
Second Line	:	STE 220
City	:	CEDAR RAPIDS
State	:	IA
Zip	:	52401-1201
Country	:	US
Telephone Number	:	319-362-0632
Fax Number	:	319-362-5206

Provider Business Practice Location Address
First Line	:	118 2ND ST SE
Second Line	:	STE 220
City	:	CEDAR RAPIDS
State	:	IA
Zip	:	52401-1201
Country	:	US
Telephone Number	:	319-362-0632
Fax Number	:	319-362-5206

Authorized Official
Title or Position	:	BUSINESS MANAGER
Name	:	DAVID CAREY
Credential	:
Telephone Number	:	319-362-0632

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	04/26/2011

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