Provider Demographics
NPI:1619410735
Name:SIOUXLAND COUNSELING SERVICES, PLLC
Entity Type:Organization
Organization Name:SIOUXLAND COUNSELING SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTRO-MOCTEZUMA
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:712-522-0947
Mailing Address - Street 1:409 11TH ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51105-1332
Mailing Address - Country:US
Mailing Address - Phone:712-522-0947
Mailing Address - Fax:
Practice Address - Street 1:409 11TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51105-1332
Practice Address - Country:US
Practice Address - Phone:712-522-0947
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-21
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001675251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health