Healthcare Provider Details

I. General information

NPI: 1588958516
Provider Name (Legal Business Name): MIDWEST COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2011
Last Update Date: 07/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

523 1/2 COURT STREET
WILLIAMSBURG IA
52361
US

IV. Provider business mailing address

523 1/2 COURT STREET PO BOX 313
WILLIAMSBURG IA
52361
US

V. Phone/Fax

Practice location:
  • Phone: 319-668-1217
  • Fax:
Mailing address:
  • Phone: 319-668-1217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number06609
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number06609
License Number StateIA

VIII. Authorized Official

Name: MRS. JACQUELINE ANN WEYDERT
Title or Position: PSYCHOTHERAPIST
Credential: LISW
Phone: 319-668-1217