Healthcare Provider Details

I. General information

NPI: 1669100509
Provider Name (Legal Business Name): BIGELOW COUNSELING & THERAPY SERVICES, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2022
Last Update Date: 10/13/2022
Certification Date: 08/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3641 KIMBALL AVE # 204
WATERLOO IA
50702-5757
US

IV. Provider business mailing address

3641 KIMBALL AVE # 204
WATERLOO IA
50702-5757
US

V. Phone/Fax

Practice location:
  • Phone: 319-610-9995
  • Fax:
Mailing address:
  • Phone: 319-610-9995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MS. ANGELA BIGELOW
Title or Position: OWNER
Credential: LMHC
Phone: 319-610-9995