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General NPI Number Information
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NPI Number | 1407393259
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Entity Type | Organization
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Legal Business Name | OPTIMAE LIFESERVICES, INC.
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Dates
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Enumeration Date | 01/31/2017
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Last Update Date | 01/31/2017
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Provider Practice Location Address
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Address Line | 124 S HAZEL AVE
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City | AMES
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State | IA
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Zip | 50010-5952
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Country | US
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Telephone | 515-956-2600
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Fax | 515-956-2601
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Provider Business Mailing Address
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Address Line | 301 W BURLINGTON AVE
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City | FAIRFIELD
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State | IA
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Zip | 52556-3242
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Country | US
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Telephone | 641-472-1684
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Fax | 641-472-4609
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. WILLIAM DODDS
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Credential |
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Telephone | 515-283-1230
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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 | 850670
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 850672
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License Number State | IA
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 850671
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License Number State | IA
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