Healthcare Provider Details

I. General information

NPI: 1336168350
Provider Name (Legal Business Name): RURAL FAMILY THERAPY SERVICES L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 E TAYLOR ST
CRESTON IA
50801-4057
US

IV. Provider business mailing address

PO BOX 361
AFTON IA
50830-0361
US

V. Phone/Fax

Practice location:
  • Phone: 641-782-7212
  • Fax: 641-347-5060
Mailing address:
  • Phone: 641-347-5060
  • Fax: 641-347-5060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number01222
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier01199
Identifier TypeOTHER
Identifier StateIA
Identifier IssuerBC/BS PROVIDER NUMBER
# 2
Identifier0010215
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer

VIII. Authorized Official

Name: MS. THERESA BENSKY
Title or Position: CLINICAL ADMINISTRATOR
Credential: L.I.S.W.
Phone: 641-347-5060