Healthcare Provider Details

I. General information

NPI: 1184435687
Provider Name (Legal Business Name): BETSY R JEPSEN T-LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2025
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5415 NW 88TH ST STE 100
JOHNSTON IA
50131-2951
US

IV. Provider business mailing address

620 NE BOWMAN DR
WAUKEE IA
50263-5033
US

V. Phone/Fax

Practice location:
  • Phone: 515-727-1338
  • Fax:
Mailing address:
  • Phone: 515-210-5109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number128203
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: