Healthcare Provider Details

I. General information

NPI: 1154682318
Provider Name (Legal Business Name): DEGINESH WORKU LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2012
Last Update Date: 06/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 W 3RD ST
CEDAR FALLS IA
50613-2745
US

IV. Provider business mailing address

324 W 3RD ST
CEDAR FALLS IA
50613-2745
US

V. Phone/Fax

Practice location:
  • Phone: 319-277-4383
  • Fax: 319-268-2207
Mailing address:
  • Phone: 319-277-4383
  • Fax: 319-268-2207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number00434
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number01148
License Number StateMN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: