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General NPI Number Information
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NPI Number | 1629789854
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Entity Type | Organization
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Legal Business Name | ELEVATING AWARENESS THERAPY SERVICES, LLC
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Dates
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Enumeration Date | 12/08/2022
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Last Update Date | 12/08/2022
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Provider Practice Location Address
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Address Line | 3641 KIMBALL AVE STE 207
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City | WATERLOO
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State | IA
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Zip | 50702-5757
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Country | US
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Telephone | 319-318-0178
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Fax | 319-320-1121
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Provider Business Mailing Address
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Address Line | 3641 KIMBALL AVE STE 207
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City | WATERLOO
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State | IA
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Zip | 50702-5757
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Country | US
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Telephone | 319-318-0178
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Fax | 319-320-1121
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Authorized Official
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Title or Position | OWNER/LMFT
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Name | NICHOLE CLARKE
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Credential | M.A., LMFT
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Telephone | 319-621-5300
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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 |
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License Number State |
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