Healthcare Provider Details

I. General information

NPI: 1528505369
Provider Name (Legal Business Name): CEDAR VALLEY COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2017
Last Update Date: 03/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4521 CHADWICK RD SUITE 2
CEDAR FALLS IA
50613-8045
US

IV. Provider business mailing address

PO BOX 485
CEDAR FALLS IA
50613-0026
US

V. Phone/Fax

Practice location:
  • Phone: 319-239-3533
  • Fax:
Mailing address:
  • Phone: 319-239-3533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number001292
License Number StateIA

VII. Legacy identifiers

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

VIII. Authorized Official

Name: JACOB DONAVON SCHAEFER
Title or Position: OWNER
Credential: LMHC
Phone: 319-239-3533