Provider Demographics
NPI:1093862492
Name:HEMESATH, CAROL (MS, LMHC)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:HEMESATH
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:DECORAH
Mailing Address - State:IA
Mailing Address - Zip Code:52101-1607
Mailing Address - Country:US
Mailing Address - Phone:563-387-0428
Mailing Address - Fax:563-387-0428
Practice Address - Street 1:709 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:DECORAH
Practice Address - State:IA
Practice Address - Zip Code:52101-1607
Practice Address - Country:US
Practice Address - Phone:563-387-0428
Practice Address - Fax:563-387-0428
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00315101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health