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General NPI Number Information
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NPI Number | 1639200033
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Entity Type | Organization
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Legal Business Name | EYERLY BALL COMMUNITY MENTAL HEALTH SERVICES
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Dates
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Enumeration Date | 03/08/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1301 CENTER ST
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City | DES MOINES
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State | IA
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Zip | 50309-1004
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Country | US
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Telephone | 515-243-5181
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Fax |
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Provider Business Mailing Address
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Address Line | 1301 CENTER ST
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City | DES MOINES
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State | IA
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Zip | 50309-1004
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Country | US
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Telephone | 515-243-5181
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF PROFESSIONAL SERVICES
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Name | LAWRENCE J HEJTMANEK SR.
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Credential | LISW
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Telephone | 515-243-5181
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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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