MEDICARE: MJC THERAPEUTIC COUNSELING SERVICES 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	00072	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	37137	OTHER	IA	WELLMARK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518328988
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MJC THERAPEUTIC COUNSELING SERVICES LLC

Provider Business Mailing Address
First Line	:	1000 73RD ST
Second Line	:	STE 5
City	:	WINDSOR HEIGHTS
State	:	IA
Zip	:	50324-1321
Country	:	US
Telephone Number	:	515-222-1175
Fax Number	:	515-222-0935

Provider Business Practice Location Address
First Line	:	1000 73RD ST
Second Line	:	STE 5
City	:	WINDSOR HEIGHTS
State	:	IA
Zip	:	50324-1321
Country	:	US
Telephone Number	:	515-222-1175
Fax Number	:	515-222-0935

Authorized Official
Title or Position	:	OWNER
Name	:	MARGARET JANE CONRAD
Credential	:	LISW
Telephone Number	:	515-222-1175

Provider Enumeration Date	:	03/14/2016
Last Update Date	:	03/21/2016

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