Provider Demographics
NPI:1659991610
Name:KIVISTO COUNSELING AND THERAPY LLC
Entity Type:Organization
Organization Name:KIVISTO COUNSELING AND THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:RACHEL
Authorized Official - Last Name:KIVISTO
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:563-265-0825
Mailing Address - Street 1:24666 257TH ST
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:IA
Mailing Address - Zip Code:52768-9727
Mailing Address - Country:US
Mailing Address - Phone:563-265-0825
Mailing Address - Fax:
Practice Address - Street 1:2550 MIDDLE RD STE 3
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-3298
Practice Address - Country:US
Practice Address - Phone:563-265-0825
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-20
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health