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General NPI Number Information
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NPI Number | 1366060584
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Entity Type | Organization
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Legal Business Name | RURAL BEHAVIORAL HEALTH, LLC
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Dates
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Enumeration Date | 07/14/2020
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Last Update Date | 07/14/2020
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Provider Practice Location Address
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Address Line | 2212 IRONWOOD CT
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City | AMES
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State | IA
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Zip | 50014-7872
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Country | US
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Telephone | 423-596-1949
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Fax | 515-450-5323
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Provider Business Mailing Address
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Address Line | 2212 IRONWOOD CT
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City | AMES
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State | IA
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Zip | 50014-7872
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Country | US
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Telephone | 423-596-1949
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Fax | 515-450-5323
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Authorized Official
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Title or Position | PRINCIPAL
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Name | MR. DAVID WILLIAM JOLLY
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Credential |
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Telephone | 423-596-1949
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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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