Provider Demographics
NPI:1003818956
Name:SOUTHARD HARRISON INC
Entity Type:Organization
Organization Name:SOUTHARD HARRISON INC
Other - Org Name:THERAPY ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR THERAPY ASSOCIATES
Authorized Official - Prefix:
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:SOUTHARD
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:563-382-2662
Mailing Address - Street 1:314 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DECORAH
Mailing Address - State:IA
Mailing Address - Zip Code:52101-1716
Mailing Address - Country:US
Mailing Address - Phone:563-382-2662
Mailing Address - Fax:563-382-2662
Practice Address - Street 1:314 W MAIN ST
Practice Address - Street 2:
Practice Address - City:DECORAH
Practice Address - State:IA
Practice Address - Zip Code:52101-1716
Practice Address - Country:US
Practice Address - Phone:563-382-2662
Practice Address - Fax:563-382-2662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
41019OtherWELLMARK/KARLA PRESLER
11880OtherWELLMARK/MARILYN SOUTHARD
41019OtherWELLMARK/KARLA PRESLER