Healthcare Provider Details

I. General information

NPI: 1083103790
Provider Name (Legal Business Name): LION'S HEART PSYCHOLOGICAL SERVICES, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2018
Last Update Date: 05/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5250 N PARK PL NE STE 109
CEDAR RAPIDS IA
52402-6221
US

IV. Provider business mailing address

5250 N PARK PL NE STE 109
CEDAR RAPIDS IA
52402-6221
US

V. Phone/Fax

Practice location:
  • Phone: 319-249-9237
  • Fax: 319-377-5936
Mailing address:
  • Phone: 319-249-9237
  • Fax: 319-377-5936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number079981
License Number StateIA

VII. Legacy identifiers

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

VIII. Authorized Official

Name: DR. KARI FINNEGAN
Title or Position: LICENSED PSYCHOLOGIIST
Credential: PH.D.
Phone: 319-249-9237