Healthcare Provider Details

I. General information

NPI: 1962555003
Provider Name (Legal Business Name): WOLFLEG COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2007
Last Update Date: 11/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2871 HEINZ RD STE 'B'
IOWA CITY IA
52240-8196
US

IV. Provider business mailing address

2871 HEINZ RD STE 'B'
IOWA CITY IA
52240-8196
US

V. Phone/Fax

Practice location:
  • Phone: 319-936-6248
  • Fax:
Mailing address:
  • Phone: 319-936-6248
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number02512
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number02512
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number02512
License Number StateIA

VIII. Authorized Official

Name: JAMES ROBERT SMITH
Title or Position: PRESIDENT
Credential: LISW
Phone: 319-936-6248