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General NPI Number Information
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NPI Number | 1942633417
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Entity Type | Organization
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Legal Business Name | TOWNCLOCK MENTAL HEALTH PC
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Dates
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Enumeration Date | 08/19/2013
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Last Update Date | 08/19/2013
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Provider Practice Location Address
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Address Line | 799 MAIN ST STE 370
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City | DUBUQUE
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State | IA
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Zip | 52001-6844
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Country | US
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Telephone | 563-583-4111
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Fax | 563-583-5666
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Provider Business Mailing Address
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Address Line | 799 MAIN ST STE 370
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City | DUBUQUE
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State | IA
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Zip | 52001-6844
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Country | US
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Telephone | 563-583-4111
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Fax | 563-583-5666
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Authorized Official
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Title or Position | PRINCIPLE, PRACTITIONER
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Name | MR. JOEL M LIGHTCAP
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Credential | LMHC
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Telephone | 563-583-5627
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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 | 00716
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License Number State | IA
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