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General NPI Number Information
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NPI Number | 1649636952
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Entity Type | Organization
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Legal Business Name | CADEUS BEHAVIORAL HEALTH
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Dates
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Enumeration Date | 01/04/2016
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Last Update Date | 01/04/2016
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Provider Practice Location Address
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Address Line | 4820 MORTENSEN RD. SUITE 102
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City | AMES
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State | IA
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Zip | 50014-5531
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Country | US
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Telephone | 781-552-6500
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Fax |
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Provider Business Mailing Address
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Address Line | 4820 MORTENSEN RD. SUITE 102
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City | AMES
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State | IA
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Zip | 50014-5531
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Country | US
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Telephone | 781-552-6500
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. KELLY MAUREEN CHAMPION
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Credential | PHD ABPP
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Telephone | 781-552-6500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 078389
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License Number State | IA
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