MEDICARE: CHAD MOHAMMAD THERAPY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1285426767
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHAD MOHAMMAD THERAPY LLC

Provider Business Mailing Address
First Line	:	200 STATE ST STE 202K
Second Line	:
City	:	CEDAR FALLS
State	:	IA
Zip	:	50613-3380
Country	:	US
Telephone Number	:	619-559-5769
Fax Number	:	319-575-6028

Provider Business Practice Location Address
First Line	:	200 STATE ST STE 202K
Second Line	:
City	:	CEDAR FALLS
State	:	IA
Zip	:	50613-3380
Country	:	US
Telephone Number	:	619-559-5769
Fax Number	:	319-575-6028

Authorized Official
Title or Position	:	OWNER
Name	:	MR. CHAD MOHAMMAD ELBANDAGJI
Credential	:	LISW
Telephone Number	:	619-559-5769

Provider Enumeration Date	:	05/20/2025
Last Update Date	:	05/20/2025

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