Healthcare Provider Details

I. General information

NPI: 1235737362
Provider Name (Legal Business Name): POEPPE EXPERT PSYCHOLOGICAL SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2020
Last Update Date: 05/18/2022
Certification Date: 05/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12951 UNIVERSITY AVE STE 204
CLIVE IA
50325-8293
US

IV. Provider business mailing address

12951 UNIVERSITY AVE STE 204
CLIVE IA
50325-8293
US

V. Phone/Fax

Practice location:
  • Phone: 515-575-3180
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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 Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MARK POEPPE
Title or Position: OWNER
Credential: PSY.D
Phone: 515-320-4128