Healthcare Provider Details

I. General information

NPI: 1255625190
Provider Name (Legal Business Name): CONNECTIONS FAMILY THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2011
Last Update Date: 03/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1930 SAINT ANDREWS CT NE
CEDAR RAPIDS IA
52402-5890
US

IV. Provider business mailing address

1930 SAINT ANDREWS CT NE
CEDAR RAPIDS IA
52402-5890
US

V. Phone/Fax

Practice location:
  • Phone: 319-431-5498
  • Fax:
Mailing address:
  • Phone: 319-431-5498
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number06364
License Number StateIA

VII. Legacy identifiers

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

# 1
Identifier1255402889
Identifier TypeOTHER
Identifier StateIA
Identifier IssuerINDIVIDUAL NPI

VIII. Authorized Official

Name: KERI L CHRISTENSEN
Title or Position: OWNER/THERAPIST
Credential: LISW
Phone: 319-431-5498