Healthcare Provider Details

I. General information

NPI: 1427002641
Provider Name (Legal Business Name): CLINICAL HEALTH PSYCHOLOGISTS, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 04/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2717 MINNETONKA DR CLINICAL HEALTH PSYCHOLOGISTS, PLC
CEDAR FALLS IA
50613-1531
US

IV. Provider business mailing address

P.O. BOX 1066 CLINICAL HEALTH PSYCHOLOGISTS, PLC
CEDAR FALLS IA
50613-0048
US

V. Phone/Fax

Practice location:
  • Phone: 319-240-7456
  • Fax:
Mailing address:
  • Phone: 319-240-7456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier36264
Identifier TypeOTHER
Identifier StateIA
Identifier IssuerBLUE CROSS BLUE SHIELD
# 2
Identifier708085000
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer

VIII. Authorized Official

Name: NAOMI BETH MCCORMICK
Title or Position: CEO
Credential: PH.D.
Phone: 319-240-7456