Healthcare Provider Details

I. General information

NPI: 1487168902
Provider Name (Legal Business Name): LEONA CHILDS TLMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2017
Last Update Date: 11/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3726 QUEEN CT SW STE 103
CEDAR RAPIDS IA
52404-3903
US

IV. Provider business mailing address

2712 DALEWOOD AVE SE
CEDAR RAPIDS IA
52403-3031
US

V. Phone/Fax

Practice location:
  • Phone: 319-361-6529
  • Fax:
Mailing address:
  • Phone: 319-721-9024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number086784
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: