Provider Demographics
NPI:1558076927
Name:SERENITY COUNSELING WELLNESS, LLC
Entity Type:Organization
Organization Name:SERENITY COUNSELING WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:319-481-2296
Mailing Address - Street 1:PO BOX 92
Mailing Address - Street 2:
Mailing Address - City:MAYNARD
Mailing Address - State:IA
Mailing Address - Zip Code:50655-0092
Mailing Address - Country:US
Mailing Address - Phone:319-481-2296
Mailing Address - Fax:
Practice Address - Street 1:104 W 2ND ST
Practice Address - Street 2:
Practice Address - City:SUMNER
Practice Address - State:IA
Practice Address - Zip Code:50674-1145
Practice Address - Country:US
Practice Address - Phone:319-481-2296
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-19
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1093314551OtherNPI