Provider Demographics
NPI:1467840470
Name:HEARTLAND INTEGRATIVE PSYCHIATRIC SERVICES CO
Entity Type:Organization
Organization Name:HEARTLAND INTEGRATIVE PSYCHIATRIC SERVICES CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JOELLEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:KUBIK
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:319-404-0461
Mailing Address - Street 1:2587 130TH ST
Mailing Address - Street 2:
Mailing Address - City:TRAER
Mailing Address - State:IA
Mailing Address - Zip Code:50675-9550
Mailing Address - Country:US
Mailing Address - Phone:319-404-0461
Mailing Address - Fax:
Practice Address - Street 1:2587 130TH ST
Practice Address - Street 2:
Practice Address - City:TRAER
Practice Address - State:IA
Practice Address - Zip Code:50675-9550
Practice Address - Country:US
Practice Address - Phone:319-404-0461
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-26
Last Update Date:2014-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAG067317363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty