=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831645233
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LINDA ROBINSON CMHPSS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/27/2016
-----------------------------------------------------
Last Update Date | 08/27/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 799 MAIN ST SUITE 370
-----------------------------------------------------
City | DUBUQUE
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 52001-6844
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 563-583-4111
-----------------------------------------------------
Fax | 563-583-5666
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 799 MAIN ST SUITE 370
-----------------------------------------------------
City | DUBUQUE
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 52001-6844
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 563-583-4111
-----------------------------------------------------
Fax | 563-583-5666
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MR. JOEL M LIGHTCAP
-----------------------------------------------------
Credential | CRC,LMHC,LPC
-----------------------------------------------------
Telephone | 563-583-5627
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 175T00000X
-----------------------------------------------------
Taxonomy Name | Peer Specialist
-----------------------------------------------------
License Number | MH14035
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------