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General NPI Number Information
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NPI Number | 1326553009
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Entity Type | Organization
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Legal Business Name | KAI LANI CENTER FOR CREATIVE TRANSFORMATION AND PSYCHOTHERAPY
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Dates
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Enumeration Date | 12/04/2017
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Last Update Date | 03/04/2024
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Provider Practice Location Address
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Address Line | 2603 NORTHRIDGE PKWY STE 103
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City | AMES
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State | IA
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Zip | 50010-4046
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Country | US
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Telephone | 515-338-2929
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Fax | 515-337-8863
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Provider Business Mailing Address
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Address Line | 2603 NORTHRIDGE PKWY STE 103
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City | AMES
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State | IA
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Zip | 50010-4046
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Country | US
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Telephone | 515-338-2929
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Fax | 515-337-8863
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Authorized Official
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Title or Position | OWNER
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Name | MS. JOCELYN A WILSON
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Credential | MA, MDIV, LCSW, LISW
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Telephone | 515-338-2929
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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 | 008284
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License Number State | IA
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