Provider Demographics
NPI:1518328988
Name:MJC THERAPEUTIC COUNSELING SERVICES LLC
Entity Type:Organization
Organization Name:MJC THERAPEUTIC COUNSELING SERVICES LLC
Other - Org Name:MARGARET J. CONRAD, LISW
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:CONRAD
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:515-222-1175
Mailing Address - Street 1:1000 73RD ST
Mailing Address - Street 2:STE 5
Mailing Address - City:WINDSOR HEIGHTS
Mailing Address - State:IA
Mailing Address - Zip Code:50324-1321
Mailing Address - Country:US
Mailing Address - Phone:515-222-1175
Mailing Address - Fax:515-222-0935
Practice Address - Street 1:1000 73RD ST
Practice Address - Street 2:STE 5
Practice Address - City:WINDSOR HEIGHTS
Practice Address - State:IA
Practice Address - Zip Code:50324-1321
Practice Address - Country:US
Practice Address - Phone:515-222-1175
Practice Address - Fax:515-222-0935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-14
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA000721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA37137OtherWELLMARK
IA1035006Medicaid
IA1035006Medicaid