Healthcare Provider Details

I. General information

NPI: 1073066148
Provider Name (Legal Business Name): ELEMENTS FAMILY THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2016
Last Update Date: 07/24/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 N. MAIN ST.
MT PLEASANT IA
52641
US

IV. Provider business mailing address

124 N. MAIN ST.
MT PLEASANT IA
52641
US

V. Phone/Fax

Practice location:
  • Phone: 319-385-1665
  • Fax:
Mailing address:
  • Phone: 319-385-1665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number000394
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number000426
License Number StateIA

VIII. Authorized Official

Name: ANDREA HUDSON
Title or Position: CO-OWNER
Credential: LMFT
Phone: 319-385-1665