Healthcare Provider Details

I. General information

NPI: 1003737263
Provider Name (Legal Business Name): DEEP WELL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3103 MAPLEWOOD RD
AMES IA
50014-4572
US

IV. Provider business mailing address

3103 MAPLEWOOD RD
AMES IA
50014-4572
US

V. Phone/Fax

Practice location:
  • Phone: 641-919-0765
  • Fax:
Mailing address:
  • Phone: 641-919-0765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: SIDNEY BARKER
Title or Position: MEMER
Credential: LISW
Phone: 641-919-0765