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General NPI Number Information
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NPI Number | 1528166360
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Entity Type | Organization
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Legal Business Name | POWESHIEK COUNTY MENTAL HEALTH CENTER
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 02/13/2012
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Provider Practice Location Address
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Address Line | 200 4TH AVE WEST
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City | GRINNELL
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State | IA
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Zip | 50112
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Country | US
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Telephone | 641-236-6137
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Fax | 641-236-0206
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Provider Business Mailing Address
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Address Line | 200 4TH AVE WEST
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City | GRINNELL
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State | IA
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Zip | 50112
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Country | US
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Telephone | 641-236-6137
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Fax | 641-236-0206
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MYKE SELHA
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Credential | LISW
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Telephone | 641-236-6137
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State | IA
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