Healthcare Provider Details

I. General information

NPI: 1225966518
Provider Name (Legal Business Name): SETH BANDEL KITE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

818 4TH AVE
GRINNELL IA
50112-2041
US

IV. Provider business mailing address

818 4TH AVE
GRINNELL IA
50112-2041
US

V. Phone/Fax

Practice location:
  • Phone: 888-870-1775
  • Fax:
Mailing address:
  • Phone: 888-870-1775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number137225
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: