| NPI | 1184164584 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENT ALLEN DOUGLAS Mental Health Counselor 515-953-9083 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IA 001256) |
| Enumeration Date | 2017-03-03 |
| Last Update Date | 2017-03-03 |