Healthcare Provider Details

I. General information

NPI: 1558076927
Provider Name (Legal Business Name): SERENITY COUNSELING WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2023
Last Update Date: 01/26/2023
Certification Date: 01/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 W 2ND ST
SUMNER IA
50674-1145
US

IV. Provider business mailing address

PO BOX 92
MAYNARD IA
50655-0092
US

V. Phone/Fax

Practice location:
  • Phone: 319-481-2296
  • Fax:
Mailing address:
  • Phone: 319-481-2296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1093314551
Identifier TypeOTHER
Identifier State
Identifier IssuerNPI

VIII. Authorized Official

Name: CRYSTAL COLE
Title or Position: OWNER/MANAGER
Credential: LISW
Phone: 319-481-2296