| NPI | 1659453850 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES WADLE Medical Director 515-270-1344 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IA 00428) |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2020-08-22 |