Healthcare Provider Details

I. General information

NPI: 1669728606
Provider Name (Legal Business Name): JENISE ELIZABETH RYCHNOVSKY LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2012
Last Update Date: 07/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5415 NW 88TH ST SUITE 100
JOHNSTON IA
50131-2950
US

IV. Provider business mailing address

418 6TH AVE UNIT 1102
DES MOINES IA
50309-2407
US

V. Phone/Fax

Practice location:
  • Phone: 515-727-1338
  • Fax: 515-727-1340
Mailing address:
  • Phone: 515-988-7282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number001255
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: