=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861591901
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CENTRAL IOWA THERAPY ASSOCIATES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/22/2006
-----------------------------------------------------
Last Update Date | 12/04/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 906 9TH ST STE. 218
-----------------------------------------------------
City | BOONE
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50036-2760
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 515-291-8889
-----------------------------------------------------
Fax | 515-292-7698
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6310 PRAIRIE RIDGE DRIVE
-----------------------------------------------------
City | AMES
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50014
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 515-291-8889
-----------------------------------------------------
Fax | 515-292-7698
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | MICHAEL P MCCLAIN
-----------------------------------------------------
Credential | PHD
-----------------------------------------------------
Telephone | 515-291-8889
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 156
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------