MEDICARE: KINGDOM COUNSELING 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	106H00000X	Marriage & Family Therapist
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1962079434
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KINGDOM COUNSELING LLC

Provider Business Mailing Address
First Line	:	1603 22ND ST STE 200
Second Line	:
City	:	WEST DES MOINES
State	:	IA
Zip	:	50266-1410
Country	:	US
Telephone Number	:	515-601-0411
Fax Number	:

Provider Business Practice Location Address
First Line	:	1603 22ND ST STE 200
Second Line	:
City	:	WEST DES MOINES
State	:	IA
Zip	:	50266-1410
Country	:	US
Telephone Number	:	515-601-0411
Fax Number	:

Authorized Official
Title or Position	:	OWNER & THERAPIST
Name	:	MATTHEW NESS
Credential	:	LMHC, LMFT
Telephone Number	:	515-601-0411

Provider Enumeration Date	:	06/04/2021
Last Update Date	:	07/29/2021

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Directions to “KINGDOM COUNSELING LLC ” Practice Location

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