Provider Demographics
NPI:1639629082
Name:DERFUS COUNSELING SERVICES, INC.
Entity Type:Organization
Organization Name:DERFUS COUNSELING SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:RICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:DERFUS
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:319-936-7008
Mailing Address - Street 1:1221 PARK PL NE
Mailing Address - Street 2:SUITE E3
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-2001
Mailing Address - Country:US
Mailing Address - Phone:319-936-7008
Mailing Address - Fax:319-363-0307
Practice Address - Street 1:1221 PARK PL NE
Practice Address - Street 2:SUITE E3
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-2001
Practice Address - Country:US
Practice Address - Phone:319-936-7008
Practice Address - Fax:319-363-0307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-10
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0073151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty