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General NPI Number Information
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NPI Number | 1265070197
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Entity Type | Organization
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Legal Business Name | SRB COUNSELING, LLC
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Dates
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Enumeration Date | 12/10/2019
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Last Update Date | 12/10/2019
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Provider Practice Location Address
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Address Line | 799 MAIN ST STE 350
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City | DUBUQUE
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State | IA
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Zip | 52001-6825
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Country | US
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Telephone | 563-557-6870
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Fax | 563-557-6870
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Provider Business Mailing Address
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Address Line | 3055 INDIANA CT
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City | DUBUQUE
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State | IA
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Zip | 52001-5482
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Country | US
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Telephone | 563-581-2064
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Fax |
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Authorized Official
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Title or Position | OWNER, THERAPIST
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Name | STACEY RICHARD-BAAL
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Credential | LISC, LCSW
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Telephone | 563-557-6870
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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 |
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License Number State |
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