Healthcare Provider Details

I. General information

NPI: 1740279355
Provider Name (Legal Business Name): FAMILY PSYCHOLOGY ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2005
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 CENTER POINT RD NE
CEDAR RAPIDS IA
52402-6571
US

IV. Provider business mailing address

1221 CENTER POINT RD NE
CEDAR RAPIDS IA
52402-6571
US

V. Phone/Fax

Practice location:
  • Phone: 319-378-1199
  • Fax: 319-378-7497
Mailing address:
  • Phone: 319-378-1199
  • Fax: 319-378-7497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINE A BADER-SANDS
Title or Position: OFFICE MANAGER
Credential:
Phone: 319-378-1199