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General NPI Number Information
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NPI Number | 1710530175
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Entity Type | Individual
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Provider Name | BEN MINECK
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Gender | Male
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Dates
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Enumeration Date | 07/24/2019
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Last Update Date | 07/24/2019
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Provider Practice Location Address
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Address Line | 204 GLENN ST SE STE 2
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City | MOUNT VERNON
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State | IA
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Zip | 52314-1501
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Country | US
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Telephone | 319-423-2244
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Fax |
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Provider Business Mailing Address
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Address Line | 1530 RANMAR CT
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City | ELY
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State | IA
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Zip | 52227-9592
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Country | US
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Telephone | 319-423-2244
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 096400
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License Number State | IA
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