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General NPI Number Information
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NPI Number | 1063374619
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Entity Type | Organization
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Legal Business Name | THERAPEUTIC ALLIANCE IOWA LLC
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Dates
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Enumeration Date | 12/02/2025
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Last Update Date | 12/06/2025
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Provider Practice Location Address
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Address Line | 1435 31ST ST NE STE A
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City | CEDAR RAPIDS
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State | IA
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Zip | 52402-4056
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Country | US
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Telephone | 319-214-5053
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Fax | 319-208-3742
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Provider Business Mailing Address
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Address Line | 1435 31ST ST NE STE A
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City | CEDAR RAPIDS
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State | IA
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Zip | 52402-4056
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Country | US
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Telephone | 319-214-5053
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Fax | 319-208-3742
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Authorized Official
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Title or Position | MARRIAGE AND FAMILY THERAPIST
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Name | STACY LYNN GROOMS
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Credential | LMFT
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Telephone | 319-214-5053
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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