Provider Demographics
NPI:1639564834
Name:WOLF, KIRA (LMHC, IADC)
Entity Type:Individual
Prefix:MRS
First Name:KIRA
Middle Name:
Last Name:WOLF
Suffix:
Gender:F
Credentials:LMHC, IADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7069 HICKORY LN
Mailing Address - Street 2:
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50322-1892
Mailing Address - Country:US
Mailing Address - Phone:319-631-5521
Mailing Address - Fax:
Practice Address - Street 1:7069 HICKORY LN
Practice Address - Street 2:
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50322-1892
Practice Address - Country:US
Practice Address - Phone:319-631-5521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-03
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA11040101YA0400X
IA001276101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)