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General NPI Number Information
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NPI Number | 1306588330
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Entity Type | Organization
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Legal Business Name | THERAPEUTIC INNOVATIONS, PLLC
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Dates
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Enumeration Date | 04/11/2022
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Last Update Date | 04/11/2022
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Provider Practice Location Address
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Address Line | 100 W 4TH ST
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City | VINTON
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State | IA
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Zip | 52349-1120
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Country | US
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Telephone | 319-540-5643
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Fax | 319-409-8120
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Provider Business Mailing Address
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Address Line | 100 W 4TH ST
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City | VINTON
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State | IA
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Zip | 52349-1120
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Country | US
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Telephone | 319-540-5643
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Fax | 319-409-8120
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Authorized Official
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Title or Position | LICENSED MENTAL HEALTH COUNSELOR
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Name | VANESSA WEST
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Credential | PH.D., LMHC
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Telephone | 319-540-5643
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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