Provider Demographics
NPI:1639226921
Name:SHEELEY, NEAL (LMFT, LICSW)
Entity Type:Individual
Prefix:
First Name:NEAL
Middle Name:
Last Name:SHEELEY
Suffix:
Gender:M
Credentials:LMFT, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1260 2ND AVE SE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52403-4002
Mailing Address - Country:US
Mailing Address - Phone:319-297-2300
Mailing Address - Fax:
Practice Address - Street 1:1260 2ND AVE SE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52403-4002
Practice Address - Country:US
Practice Address - Phone:319-297-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00068106H00000X
MN088761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA02205599Medicaid