Provider Demographics
NPI:1437139706
Name:RURAL FAMILY THERAPY SERVICES, LLC
Entity Type:Organization
Organization Name:RURAL FAMILY THERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PAT
Authorized Official - Middle Name:L
Authorized Official - Last Name:LOWENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:641-782-7212
Mailing Address - Street 1:PO BOX 361
Mailing Address - Street 2:
Mailing Address - City:AFTON
Mailing Address - State:IA
Mailing Address - Zip Code:50830-0361
Mailing Address - Country:US
Mailing Address - Phone:641-347-5060
Mailing Address - Fax:641-347-5060
Practice Address - Street 1:505 E TAYLOR ST
Practice Address - Street 2:
Practice Address - City:CRESTON
Practice Address - State:IA
Practice Address - Zip Code:50801-4057
Practice Address - Country:US
Practice Address - Phone:641-782-7212
Practice Address - Fax:641-347-5060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01250 01222101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA01199OtherWELLMARK NUMBER
IA36217OtherWELLMARK NUMBER
IA29-88-001OtherIA POS PROVIDER #
IA0010215Medicaid
IA=========OtherEIN