Healthcare Provider Details

I. General information

NPI: 1184587768
Provider Name (Legal Business Name): UNBRIDLED SERENITY WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4403 1ST AVE SE STE 512
CEDAR RAPIDS IA
52402-3249
US

IV. Provider business mailing address

4403 1ST AVE SE STE 512
CEDAR RAPIDS IA
52402-3249
US

V. Phone/Fax

Practice location:
  • Phone: 319-899-1144
  • Fax: 866-861-9368
Mailing address:
  • Phone: 319-899-1144
  • Fax: 866-861-9368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: STORMY HINTON
Title or Position: LICENSED INDEPENDENT SOCIAL WORKER
Credential: LISW
Phone: 319-899-1144