Healthcare Provider Details

I. General information

NPI: 1124912902
Provider Name (Legal Business Name): JMG THERAPY AND COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2025
Last Update Date: 06/05/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2190 NW 82ND ST STE D
CLIVE IA
50325-5509
US

IV. Provider business mailing address

2190 NW 82ND ST STE D
CLIVE IA
50325-5509
US

V. Phone/Fax

Practice location:
  • Phone: 515-777-1209
  • Fax: 515-349-5339
Mailing address:
  • Phone: 515-777-1209
  • Fax: 515-349-5339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
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: MS. ANDREA J GUSTAFSON
Title or Position: OWNER/THERAPIST
Credential: LISW
Phone: 515-250-2012