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1285791376
JACK FORMANEK
COUNCIL BLUFFS, IA
NPI
1285791376
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
101YM0800X Counselor, Mental Health
(Licence: IA 205)
Enumeration Date
2007-01-02
Last Update Date
2007-07-08
Business Address
-- JACK FORMANEK MS, LMHP
307 E VIEW DR
COUNCIL BLUFFS, IA 51503-0464
Phone number: 712-325-1584
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Mailing Address
-- JACK FORMANEK MS, LMHP
307 E VIEW DR
COUNCIL BLUFFS, IA 51503-0464
Phone number: 712-325-1584
Copy
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