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General NPI Number Information
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NPI Number | 1821711284
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Entity Type | Organization
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Legal Business Name | CORNSILK - JOAN IWEN COUNSELING LLC
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Dates
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Enumeration Date | 09/21/2022
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Last Update Date | 09/21/2022
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Provider Practice Location Address
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Address Line | 110 N 37TH ST STE 301
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City | NORFOLK
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State | NE
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Zip | 68701-3283
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Country | US
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Telephone | 402-649-4936
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Fax |
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Provider Business Mailing Address
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Address Line | 110 N 37TH ST STE 301
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City | NORFOLK
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State | NE
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Zip | 68701-3283
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Country | US
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Telephone | 402-649-4936
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Fax |
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Authorized Official
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Title or Position | LICENSED MENTAL HEALTH PRACTITIONER
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Name | JOAN M IWEN
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Credential | LMHP
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Telephone | 402-649-4936
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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