Provider Demographics
NPI:1346395027
Name:COUNSELING AND THERAPY ASSOCIATES,LLC
Entity Type:Organization
Organization Name:COUNSELING AND THERAPY ASSOCIATES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHULZ
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:319-236-7701
Mailing Address - Street 1:3120 KIMBALL AVE
Mailing Address - Street 2:SUITE B & C
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50702-5272
Mailing Address - Country:US
Mailing Address - Phone:319-236-7701
Mailing Address - Fax:319-226-3263
Practice Address - Street 1:3120 KIMBALL AVE
Practice Address - Street 2:SUITE B & C
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50702-5272
Practice Address - Country:US
Practice Address - Phone:319-236-7701
Practice Address - Fax:319-226-3263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0177394Medicaid