Healthcare Provider Details

I. General information

NPI: 1255225389
Provider Name (Legal Business Name): REDEFINE PSYCHIATRY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2025
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1370 NW 114TH ST STE 109
CLIVE IA
50325-7011
US

IV. Provider business mailing address

1370 NW 114TH ST STE 109
CLIVE IA
50325-7011
US

V. Phone/Fax

Practice location:
  • Phone: 515-316-6736
  • Fax: 515-495-7257
Mailing address:
  • Phone: 515-316-6736
  • Fax: 515-495-7257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANA VALENCIA
Title or Position: ARNP/OWNER
Credential:
Phone: 515-316-6736