Provider Demographics
NPI:1437473733
Name:BEAR CREEK THERAPY PLLC
Entity Type:Organization
Organization Name:BEAR CREEK THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:A
Authorized Official - Last Name:IHNS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:563-552-7080
Mailing Address - Street 1:1176 130TH AVE
Mailing Address - Street 2:
Mailing Address - City:LOST NATION
Mailing Address - State:IA
Mailing Address - Zip Code:52254-9699
Mailing Address - Country:US
Mailing Address - Phone:563-552-7080
Mailing Address - Fax:
Practice Address - Street 1:229 S MAIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:MAQUOKETA
Practice Address - State:IA
Practice Address - Zip Code:52060-3056
Practice Address - Country:US
Practice Address - Phone:563-552-7080
Practice Address - Fax:800-394-1580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-16
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00999103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty