Healthcare Provider Details

I. General information

NPI: 1265070197
Provider Name (Legal Business Name): SRB COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2019
Last Update Date: 12/10/2019
Certification Date: 12/10/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

799 MAIN ST STE 350
DUBUQUE IA
52001-6825
US

IV. Provider business mailing address

3055 INDIANA CT
DUBUQUE IA
52001-5482
US

V. Phone/Fax

Practice location:
  • Phone: 563-557-6870
  • Fax: 563-557-6870
Mailing address:
  • Phone: 563-581-2064
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: STACEY RICHARD-BAAL
Title or Position: OWNER, THERAPIST
Credential: LISC, LCSW
Phone: 563-557-6870