Provider Demographics
NPI:1609824911
Name:CEDAR RAPIDS COUNSELING & PSYCHOTHERAPY GROUP LLP
Entity Type:Organization
Organization Name:CEDAR RAPIDS COUNSELING & PSYCHOTHERAPY GROUP LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:CAREY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-362-0632
Mailing Address - Street 1:118 2ND ST SE
Mailing Address - Street 2:STE 220
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52401-1201
Mailing Address - Country:US
Mailing Address - Phone:319-362-0632
Mailing Address - Fax:319-362-5206
Practice Address - Street 1:118 2ND ST SE
Practice Address - Street 2:STE 220
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52401-1201
Practice Address - Country:US
Practice Address - Phone:319-362-0632
Practice Address - Fax:319-362-5206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA103T00000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0474924Medicaid
IA36070OtherWELLMARK BCBS
IA0474924Medicaid