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General NPI Number Information
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NPI Number | 1972859288
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Entity Type | Organization
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Legal Business Name | NOBLE CEDAR PSYCHOLOGICAL INSTITUTE
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Dates
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Enumeration Date | 07/24/2012
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Last Update Date | 02/28/2018
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Provider Practice Location Address
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Address Line | 1425 W. 5TH STREET SUITE 1
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City | WATERLOO
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State | IA
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Zip | 50702
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Country | US
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Telephone | 319-883-9811
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Fax | 319-883-9811
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Provider Business Mailing Address
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Address Line | 802 RAINBOW DR STE 1
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City | WATERLOO
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State | IA
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Zip | 50701-1133
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Country | US
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Telephone | 319-883-9811
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Fax | 319-883-9811
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Authorized Official
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Title or Position | MANAGER AND CLINICAL DIRECTOR
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Name | DR. CHRISTINE GUEVARA
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Credential | PH.D.
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Telephone | 319-883-9811
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 001144
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License Number State | IA
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