Healthcare Provider Details

I. General information

NPI: 1871409292
Provider Name (Legal Business Name): LILY GRACE D'AMOUR LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 4TH ST NW
SIOUX CENTER IA
51250-1870
US

IV. Provider business mailing address

119 4TH ST NE
SIOUX CENTER IA
51250-1727
US

V. Phone/Fax

Practice location:
  • Phone: 712-722-1700
  • Fax:
Mailing address:
  • Phone: 320-296-0738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number139363
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: