Healthcare Provider Details

I. General information

NPI: 1679658694
Provider Name (Legal Business Name): KENDALL FATE LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 07/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2802 ORCHARD DR
CEDAR FALLS IA
50613-5898
US

IV. Provider business mailing address

2101 KIMBALL AVE LL14
WATERLOO IA
50702-5063
US

V. Phone/Fax

Practice location:
  • Phone: 319-268-9700
  • Fax: 319-268-1934
Mailing address:
  • Phone: 319-272-1590
  • Fax: 319-272-1535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number00221
License Number StateIA

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: