Provider Demographics
NPI:1326553009
Name:KAI LANI CENTER FOR CREATIVE TRANSFORMATION AND PSYCHOTHERAPY
Entity Type:Organization
Organization Name:KAI LANI CENTER FOR CREATIVE TRANSFORMATION AND PSYCHOTHERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JOCELYN
Authorized Official - Middle Name:A
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:MA, MDIV, LCSW, LISW
Authorized Official - Phone:515-338-2929
Mailing Address - Street 1:2603 NORTHRIDGE PKWY STE 103
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-4046
Mailing Address - Country:US
Mailing Address - Phone:515-338-2929
Mailing Address - Fax:515-337-8863
Practice Address - Street 1:2603 NORTHRIDGE PKWY STE 103
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-4046
Practice Address - Country:US
Practice Address - Phone:515-338-2929
Practice Address - Fax:515-337-8863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0082841041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty