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General NPI Number Information
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NPI Number | 1942932736
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Entity Type | Organization
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Legal Business Name | CORALVILLE COUNSELING CENTER LLC
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Dates
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Enumeration Date | 06/29/2022
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Last Update Date | 06/29/2022
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Provider Practice Location Address
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Address Line | 2431 CORAL CT STE 4
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City | CORALVILLE
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State | IA
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Zip | 52241-2838
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Country | US
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Telephone | 319-359-7047
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Fax |
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Provider Business Mailing Address
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Address Line | 513 REDBIRD RUN
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City | TIFFIN
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State | IA
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Zip | 52340-9309
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Country | US
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Telephone | 319-359-7047
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | MRS. BOBBY JO SALM
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Credential | LISW, LICW
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Telephone | 319-330-7227
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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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