Healthcare Provider Details

I. General information

NPI: 1437558004
Provider Name (Legal Business Name): JOHN ANTHONY BISENIUS LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2014
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1444 NW 124TH CT
CLIVE IA
50325-8150
US

IV. Provider business mailing address

1545 SE GREENBRIAR CIR
WAUKEE IA
50263-9693
US

V. Phone/Fax

Practice location:
  • Phone: 515-375-1160
  • Fax: 515-477-2255
Mailing address:
  • Phone: 515-375-1160
  • Fax: 515-477-2255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number073774
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: