Provider Demographics
NPI:1548736085
Name:NCC PSYCHIATRIC SERVICES PLLC
Entity Type:Organization
Organization Name:NCC PSYCHIATRIC SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:C
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:712-541-6620
Mailing Address - Street 1:PO BOX 509
Mailing Address - Street 2:
Mailing Address - City:LE MARS
Mailing Address - State:IA
Mailing Address - Zip Code:51031-0509
Mailing Address - Country:US
Mailing Address - Phone:712-541-6620
Mailing Address - Fax:855-344-1082
Practice Address - Street 1:16507 MAHOGANY AVE
Practice Address - Street 2:
Practice Address - City:LE MARS
Practice Address - State:IA
Practice Address - Zip Code:51031-8761
Practice Address - Country:US
Practice Address - Phone:712-541-6620
Practice Address - Fax:855-344-1082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-23
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty