Provider Demographics
NPI:1659743656
Name:LIBERTY THERAPY ASSOCIATES LLC
Entity Type:Organization
Organization Name:LIBERTY THERAPY ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:SKOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-321-9790
Mailing Address - Street 1:595 ASHLEY CT STE 1
Mailing Address - Street 2:
Mailing Address - City:NORTH LIBERTY
Mailing Address - State:IA
Mailing Address - Zip Code:52317-4758
Mailing Address - Country:US
Mailing Address - Phone:319-321-9790
Mailing Address - Fax:
Practice Address - Street 1:595 ASHLEY CT STE 1
Practice Address - Street 2:
Practice Address - City:NORTH LIBERTY
Practice Address - State:IA
Practice Address - Zip Code:52317-4758
Practice Address - Country:US
Practice Address - Phone:319-321-9790
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-29
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA146106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty