Healthcare Provider Details

I. General information

NPI: 1073029054
Provider Name (Legal Business Name): MANTRA ENERGY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2017
Last Update Date: 08/04/2023
Certification Date: 08/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 S PIERCE AVE STE 213
MASON CITY IA
50401-2751
US

IV. Provider business mailing address

1610 MEADOWBROOK DR
MASON CITY IA
50401-4758
US

V. Phone/Fax

Practice location:
  • Phone: 641-426-0650
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number072775
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateIA

VIII. Authorized Official

Name: EMILY HARBACHECK
Title or Position: CEO
Credential:
Phone: 507-402-8131