| NPI | 1497147011 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLEY J POLK Owner/Therapist 712-870-1445 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IA 001074) |
| Enumeration Date | 2015-02-19 |
| Last Update Date | 2025-12-01 |