Provider Demographics
NPI:1558413815
Name:SIGNAL ZONE COUNSELING, PC
Entity Type:Organization
Organization Name:SIGNAL ZONE COUNSELING, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:A
Authorized Official - Last Name:KOERNER
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:515-230-4010
Mailing Address - Street 1:PO BOX 36
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:IA
Mailing Address - Zip Code:50036-0036
Mailing Address - Country:US
Mailing Address - Phone:515-230-4010
Mailing Address - Fax:
Practice Address - Street 1:803 KEELER ST.
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:IA
Practice Address - Zip Code:50036-0036
Practice Address - Country:US
Practice Address - Phone:515-230-4010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00417251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IACOMPSYCHOtherPROVIDER NUMBER
IA246085OtherMIDLANDS CHOICE, INC
IA7897570Medicaid