Provider Demographics
NPI:1083719587
Name:FAMILY COUNSELING & PSYCHOLOGY CENTER P.C.
Entity Type:Organization
Organization Name:FAMILY COUNSELING & PSYCHOLOGY CENTER P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:COLLIN
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:LODICO
Authorized Official - Suffix:
Authorized Official - Credentials:PH D
Authorized Official - Phone:563-355-1611
Mailing Address - Street 1:2485 TECH DR
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-3262
Mailing Address - Country:US
Mailing Address - Phone:563-355-1611
Mailing Address - Fax:563-355-6617
Practice Address - Street 1:2485 TECH DR
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-3262
Practice Address - Country:US
Practice Address - Phone:563-355-1611
Practice Address - Fax:563-355-6617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0263178Medicaid
IA0263178Medicaid