| NPI | 1073966123 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TARA NISSEN Mental Health Therapist 563-579-1181 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IA 007613) |
| Enumeration Date | 2016-07-13 |
| Last Update Date | 2016-07-13 |