Provider Demographics
NPI:1619525433
Name:DOLLEN, ADAM (NCC, LMHC)
Entity Type:Individual
Prefix:MR
First Name:ADAM
Middle Name:
Last Name:DOLLEN
Suffix:
Gender:M
Credentials:NCC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 HIGHWAY 191
Mailing Address - Street 2:
Mailing Address - City:PERSIA
Mailing Address - State:IA
Mailing Address - Zip Code:51563
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:421 E ERIE ST
Practice Address - Street 2:
Practice Address - City:MISSOURI VALLEY
Practice Address - State:IA
Practice Address - Zip Code:51555
Practice Address - Country:US
Practice Address - Phone:712-307-2355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-27
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA096915101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health