Provider Demographics
NPI:1326305269
Name:ASBURY COUNSELING AND EVALUATION SERVICES, LLC
Entity Type:Organization
Organization Name:ASBURY COUNSELING AND EVALUATION SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:GOTTO
Authorized Official - Suffix:
Authorized Official - Credentials:LISW, LCSW
Authorized Official - Phone:563-588-3500
Mailing Address - Street 1:5900 SARATOGA RD
Mailing Address - Street 2:SUITE 4A
Mailing Address - City:ASBURY
Mailing Address - State:IA
Mailing Address - Zip Code:52002-2124
Mailing Address - Country:US
Mailing Address - Phone:563-588-3500
Mailing Address - Fax:563-588-3500
Practice Address - Street 1:5900 SARATOGA RD
Practice Address - Street 2:SUITE 4A
Practice Address - City:ASBURY
Practice Address - State:IA
Practice Address - Zip Code:52002-2124
Practice Address - Country:US
Practice Address - Phone:563-588-3500
Practice Address - Fax:563-588-3500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-17
Last Update Date:2012-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06001101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0736793Medicaid
IAIB2101OtherPTAN MEDICARE