Healthcare Provider Details

I. General information

NPI: 1699470260
Provider Name (Legal Business Name): THERESA R ESPINOSA LISW, IADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2023
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1619 S HIGH AVE
AMES IA
50010-8055
US

IV. Provider business mailing address

521 6TH ST
MAXWELL IA
50161-7711
US

V. Phone/Fax

Practice location:
  • Phone: 515-232-3206
  • Fax:
Mailing address:
  • Phone: 515-460-2375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number22175
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number119205
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: