Healthcare Provider Details

I. General information

NPI: 1093679029
Provider Name (Legal Business Name): PREMTHERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2140 NORCOR AVE STE 111
CORALVILLE IA
52241-9736
US

IV. Provider business mailing address

2140 NORCOR AVE STE 111
CORALVILLE IA
52241-9736
US

V. Phone/Fax

Practice location:
  • Phone: 319-423-8494
  • Fax:
Mailing address:
  • Phone: 319-423-8494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: SEJAL PATEL
Title or Position: MARRIAGE AND FAMILY THERAPIST
Credential: LMFT
Phone: 319-423-8494