=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174700835
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COUNSELING CENTER FOR INDIVIDUAL & FAMILY DEVELOPMENT LLP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/24/2008
-----------------------------------------------------
Last Update Date | 09/23/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3030 NORTHGATE DR SUITE E
-----------------------------------------------------
City | IOWA CITY
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 52245-9501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 319-337-6483
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3030 NORTHGATE DR SUITE E
-----------------------------------------------------
City | IOWA CITY
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 52245-9501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 319-337-6483
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | MS. SANDY L MURPHY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 319-337-6483
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------