Healthcare Provider Details

I. General information

NPI: 1295458859
Provider Name (Legal Business Name): TIMOTHY RICCARDO TERRANOVA LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2022
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 HICKMAN RD
DES MOINES IA
50314-1597
US

IV. Provider business mailing address

6055 NW 49TH ST
JOHNSTON IA
50131-1163
US

V. Phone/Fax

Practice location:
  • Phone: 515-282-5629
  • Fax:
Mailing address:
  • Phone: 515-322-7997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number116660
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: