Healthcare Provider Details

I. General information

NPI: 1528166360
Provider Name (Legal Business Name): POWESHIEK COUNTY MENTAL HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 02/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 4TH AVE WEST
GRINNELL IA
50112
US

IV. Provider business mailing address

200 4TH AVE WEST
GRINNELL IA
50112
US

V. Phone/Fax

Practice location:
  • Phone: 641-236-6137
  • Fax: 641-236-0206
Mailing address:
  • Phone: 641-236-6137
  • Fax: 641-236-0206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateIA

VIII. Authorized Official

Name: MYKE SELHA
Title or Position: EXECUTIVE DIRECTOR
Credential: LISW
Phone: 641-236-6137