Provider Demographics
NPI:1568554210
Name:PARKVIEW PSYCHOLOGICAL SERVICES, P.C.
Entity Type:Organization
Organization Name:PARKVIEW PSYCHOLOGICAL SERVICES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GENELL
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:712-239-1111
Mailing Address - Street 1:2910 HAMILTON BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51104-2423
Mailing Address - Country:US
Mailing Address - Phone:712-239-1111
Mailing Address - Fax:712-239-1199
Practice Address - Street 1:2910 HAMILTON BLVD STE 100
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51104-2423
Practice Address - Country:US
Practice Address - Phone:712-239-1111
Practice Address - Fax:712-239-1199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA562103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA108886Medicare ID - Type Unspecified
IAW02735Medicare UPIN