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General NPI Number Information
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NPI Number | 1790445021
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Entity Type | Organization
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Legal Business Name | TRISTATE COUNSELING & CONSULTING
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Dates
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Enumeration Date | 12/28/2021
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Last Update Date | 12/28/2021
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Provider Practice Location Address
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Address Line | 15320 WHITE OAK DR
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City | PEOSTA
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State | IA
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Zip | 52068-7103
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Country | US
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Telephone | 319-330-1082
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Fax |
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Provider Business Mailing Address
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Address Line | 15320 WHITE OAK DR
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City | PEOSTA
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State | IA
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Zip | 52068-7103
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Country | US
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Telephone | 319-330-1082
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Fax |
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Authorized Official
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Title or Position | OWNER OF ENTITY
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Name | MELISSA M ANDERSON
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Credential | MSW, LICSW
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Telephone | 319-330-1082
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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