Provider Demographics
NPI:1083903140
Name:PRIVATE VICTORIES COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:PRIVATE VICTORIES COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MARITAL & FAMILY THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:LUMSDEN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CRC, LMFT
Authorized Official - Phone:712-830-2545
Mailing Address - Street 1:410 ARIZONA STREET
Mailing Address - Street 2:
Mailing Address - City:GLIDDEN
Mailing Address - State:IA
Mailing Address - Zip Code:51443
Mailing Address - Country:US
Mailing Address - Phone:712-830-2545
Mailing Address - Fax:712-659-3867
Practice Address - Street 1:115 EAST LINCOLNWAY, SUITE 340
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:IA
Practice Address - Zip Code:50129
Practice Address - Country:US
Practice Address - Phone:712-830-2545
Practice Address - Fax:712-659-3867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-29
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA000299106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty