Provider Demographics
NPI:1053468710
Name:FAMILY PSYCHOLOGICAL SERVICES, LLC
Entity Type:Organization
Organization Name:FAMILY PSYCHOLOGICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:SUZAN
Authorized Official - Last Name:WERGER
Authorized Official - Suffix:
Authorized Official - Credentials:MA LMHC
Authorized Official - Phone:515-993-1800
Mailing Address - Street 1:PO BOX 97
Mailing Address - Street 2:
Mailing Address - City:ADEL
Mailing Address - State:IA
Mailing Address - Zip Code:50003-0097
Mailing Address - Country:US
Mailing Address - Phone:515-993-1800
Mailing Address - Fax:515-993-1801
Practice Address - Street 1:119 N 11TH ST
Practice Address - Street 2:
Practice Address - City:ADEL
Practice Address - State:IA
Practice Address - Zip Code:50003-1400
Practice Address - Country:US
Practice Address - Phone:515-993-1800
Practice Address - Fax:515-993-1801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IALMHC00218101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1010751Medicaid