Healthcare Provider Details

I. General information

NPI: 1922405653
Provider Name (Legal Business Name): CHRISTINE EWALD LMHC LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/24/2014
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 SYCAMORE ST
LA PORTE CITY IA
50651-1425
US

IV. Provider business mailing address

407 SYCAMORE ST
LA PORTE CITY IA
50651-1425
US

V. Phone/Fax

Practice location:
  • Phone: 319-895-3062
  • Fax:
Mailing address:
  • Phone: 319-269-7915
  • Fax: 888-414-9069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number12168-125
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number18720
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number001240
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: