Healthcare Provider Details

I. General information

NPI: 1093488355
Provider Name (Legal Business Name): GOOD LIFE THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2021
Last Update Date: 08/24/2021
Certification Date: 08/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 WESTOWN PKWY STE 104
WEST DES MOINES IA
50266-5936
US

IV. Provider business mailing address

5000 WESTOWN PKWY STE 104
WEST DES MOINES IA
50266-5936
US

V. Phone/Fax

Practice location:
  • Phone: 515-314-9886
  • Fax:
Mailing address:
  • Phone: 515-314-9886
  • 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

VIII. Authorized Official

Name: ANNA ZUIDEMA
Title or Position: CLINICAL DIRECTOR
Credential: MA, LMHC, NCC
Phone: 515-314-9886