Healthcare Provider Details

I. General information

NPI: 1821314808
Provider Name (Legal Business Name): CENTER FOR HEALING AND HOPE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2010
Last Update Date: 11/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

427 E KANESVILLE BLVD SUITE 102
COUNCIL BLUFFS IA
51503-9079
US

IV. Provider business mailing address

427 E KANESVILLE BLVD STE 201
COUNCIL BLUFFS IA
51503-9079
US

V. Phone/Fax

Practice location:
  • Phone: 712-256-9660
  • Fax: 712-256-9661
Mailing address:
  • Phone: 712-256-9660
  • Fax: 712-256-9661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number06799
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number06799
License Number StateIA

VIII. Authorized Official

Name: MRS. SHELIE D. LEIGHTER
Title or Position: OWNER
Credential: LISW
Phone: 712-256-9660