Provider Demographics
NPI:1669849246
Name:CHOICES THERAPY SERVICES, LLC
Entity Type:Organization
Organization Name:CHOICES THERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:WOOD-CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:641-745-0499
Mailing Address - Street 1:2829 BUENA VISTA DR
Mailing Address - Street 2:
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325-4653
Mailing Address - Country:US
Mailing Address - Phone:641-745-0499
Mailing Address - Fax:515-987-2390
Practice Address - Street 1:2829 BUENA VISTA DR
Practice Address - Street 2:
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-4653
Practice Address - Country:US
Practice Address - Phone:641-745-0499
Practice Address - Fax:515-987-2390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-30
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001613251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1740623305Medicaid