Healthcare Provider Details

I. General information

NPI: 1235711672
Provider Name (Legal Business Name): TRIVIUM LIFE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2021
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

835 GORDON DR
SIOUX CITY IA
51101-1829
US

IV. Provider business mailing address

4201 RIVERS EDGE PKWY STE 200
COUNCIL BLUFFS IA
51501-2515
US

V. Phone/Fax

Practice location:
  • Phone: 712-522-3346
  • Fax:
Mailing address:
  • Phone: 712-355-8480
  • Fax: 712-256-6502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. MICHELLE FRANCESCA SCHALLER
Title or Position: DIRECTOR OF RCM
Credential: LPC, LMHP
Phone: 712-355-8480