Healthcare Provider Details

I. General information

NPI: 1932138088
Provider Name (Legal Business Name): MARSHA DACE LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 S GEAR AVE STE 252
WEST BURLINGTON IA
52655-1691
US

IV. Provider business mailing address

PO BOX 540
WEST BURLINGTON IA
52655-0540
US

V. Phone/Fax

Practice location:
  • Phone: 319-768-3700
  • Fax: 319-768-3712
Mailing address:
  • Phone: 319-768-3450
  • Fax: 319-768-3460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: