Healthcare Provider Details

I. General information

NPI: 1831134345
Provider Name (Legal Business Name): NEW PERSPECTIVES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 08/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3302 41ST STREET
MOLINE IL
61265
US

IV. Provider business mailing address

3302 41ST STREET
MOLINE IL
61265
US

V. Phone/Fax

Practice location:
  • Phone: 309-764-3912
  • Fax: 309-736-1804
Mailing address:
  • Phone: 309-764-3912
  • Fax: 309-736-1804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number071006393
License Number StateIL

VIII. Authorized Official

Name: MISTY R WEST
Title or Position: OFFICE MANAGER
Credential:
Phone: 309-764-3912