MEDICARE: MS. ALICIA L PENA MS

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	101YM0800X	Mental Health Counselor	001333	IA

General Provider Information

NPI Number	:	1487969234
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ALICIA L PENA MS

Provider Business Mailing Address
First Line	:	3839 MERLE HAY RD STE 282
Second Line	:
City	:	DES MOINES
State	:	IA
Zip	:	50310-1321
Country	:	US
Telephone Number	:	515-707-4920
Fax Number	:

Provider Business Practice Location Address
First Line	:	3839 MERLE HAY RD STE 282
Second Line	:
City	:	DES MOINES
State	:	IA
Zip	:	50310-1321
Country	:	US
Telephone Number	:	515-707-4920
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2010
Last Update Date	:	04/01/2025

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