Provider Demographics
NPI:1417478801
Name:CORRIDOR COUNSELING, PLLC
Entity Type:Organization
Organization Name:CORRIDOR COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/OWNER & SOLE MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:LEEFERS
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:319-270-0019
Mailing Address - Street 1:PO BOX 1561
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52406-1561
Mailing Address - Country:US
Mailing Address - Phone:319-270-0019
Mailing Address - Fax:319-294-7032
Practice Address - Street 1:4403 1ST AVE SE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-3200
Practice Address - Country:US
Practice Address - Phone:319-270-0019
Practice Address - Fax:319-294-7032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-06
Last Update Date:2017-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 104100000X, 225XM0800X
IA000435106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
No225XM0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1154713964Medicaid