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General NPI Number Information
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NPI Number | 1639466709
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Entity Type | Organization
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Legal Business Name | WAPSI VALLEY FAMILY COUNSELING, LLC
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Dates
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Enumeration Date | 07/08/2011
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Last Update Date | 05/06/2022
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Provider Practice Location Address
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Address Line | 805 CHARLES ST
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City | MASONVILLE
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State | IA
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Zip | 50654-8516
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Country | US
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Telephone | 319-361-4867
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Fax | 563-927-3939
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Provider Business Mailing Address
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Address Line | 805 CHARLES ST
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City | MASONVILLE
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State | IA
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Zip | 50654-8516
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Country | US
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Telephone | 319-361-4867
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Fax | 563-927-3939
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Authorized Official
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Title or Position | OWNER
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Name | JACQUELYN KAY SCHULTZ
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Credential | LISW
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Telephone | 319-361-4867
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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 | 04543
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 04543
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License Number State | IA
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