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General NPI Number Information
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NPI Number | 1013306224
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Entity Type | Organization
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Legal Business Name | INTUITIVE HEART COUNSELING SERVICES, LLC
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Dates
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Enumeration Date | 01/12/2015
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Last Update Date | 01/12/2015
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Provider Practice Location Address
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Address Line | 6955 UNIVERSITY AVE
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City | WINDSOR HEIGHTS
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State | IA
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Zip | 50324-1540
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Country | US
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Telephone | 515-802-7348
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Fax | 515-255-3944
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Provider Business Mailing Address
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Address Line | 4517 49TH PL
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City | DES MOINES
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State | IA
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Zip | 50310-2969
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Country | US
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Telephone | 515-802-7348
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Fax | 515-255-3944
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Authorized Official
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Title or Position | OWNER/CLINICAL SOCIAL WORKER
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Name | MRS. PENNY JO NICHOLS-PETERSON
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Credential | LISW
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Telephone | 515-802-7348
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 007260
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License Number State | IA
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