Healthcare Provider Details

I. General information

NPI: 1598337917
Provider Name (Legal Business Name): FULL CIRCLE PSYCHOLOGY AFFILIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2021
Last Update Date: 07/14/2021
Certification Date: 07/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

373 COLLINS RD NE STE 203
CEDAR RAPIDS IA
52402-3167
US

IV. Provider business mailing address

373 COLLINS RD NE STE 203
CEDAR RAPIDS IA
52402-3167
US

V. Phone/Fax

Practice location:
  • Phone: 319-214-7511
  • Fax: 319-214-7512
Mailing address:
  • Phone: 319-214-7511
  • Fax: 319-214-7512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: DR. STEPHANIE ANTHONY
Title or Position: PSYCHOLOGIST/OWNER
Credential: ED.S., PH.D., HSP
Phone: 319-214-7511