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General NPI Number Information
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NPI Number | 1336357557
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Entity Type | Organization
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Legal Business Name | FAMILY TREE ASSOCIATES, LLC
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Dates
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Enumeration Date | 05/19/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1125 W 4TH ST
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City | WATERLOO
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State | IA
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Zip | 50702-2845
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Country | US
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Telephone | 319-287-5516
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Fax | 319-226-5260
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Provider Business Mailing Address
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Address Line | PO BOX 1947
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City | WATERLOO
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State | IA
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Zip | 50704-1947
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Country | US
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Telephone | 319-287-5516
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Fax | 319-226-5260
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Authorized Official
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Title or Position | EXECUTIVE OFFICER
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Name | MS. RITA M. SPEARS
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Credential | MSW
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Telephone | 319-269-4051
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 29-07-019
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License Number State | IA
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