Healthcare Provider Details

I. General information

NPI: 1396301925
Provider Name (Legal Business Name): SERENITY MENTAL HEALTH THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2019
Last Update Date: 05/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 E KIMBERLY RD UNIT 1B
DAVENPORT IA
52807-1748
US

IV. Provider business mailing address

1140 E KIMBERLY RD UNIT 1B
DAVENPORT IA
52807-1748
US

V. Phone/Fax

Practice location:
  • Phone: 563-370-2214
  • Fax:
Mailing address:
  • Phone: 563-370-2214
  • Fax:

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: JENNIFER OLSON
Title or Position: OWNER
Credential: LISW
Phone: 563-370-2214