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NPI Code Detail

MEDICARE: NICHOLE ASHLEY CLARKE TLMFT

MEDICARE: NICHOLE ASHLEY CLARKE TLMFT
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
1106H00000XMarriage & Family Therapist100708IA

General Provider Information

NPI Number : 1780278390
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICHOLE ASHLEY CLARKE TLMFT
Provider Business Mailing Address
First Line : 2720 1ST AVE NE STE 30
Second Line :
City : CEDAR RAPIDS
State : IA
Zip : 52402-4832
Country : US
Telephone Number : 319-200-5104
Fax Number : 319-200-2516
Provider Business Practice Location Address
First Line : 3812 CEDAR HEIGHTS DR
Second Line :
City : CEDAR FALLS
State : IA
Zip : 50613-6260
Country : US
Telephone Number : 319-260-2149
Fax Number : 319-200-2516
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/24/2021
Last Update Date : 02/24/2021

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