Provider Demographics
NPI:1689879678
Name:HELP CLINIC
Entity Type:Organization
Organization Name:HELP CLINIC
Other - Org Name:ICAN PROGRAM
Other - Org Type:Other Name
Authorized Official - Title/Position:MENTAL HEALTH THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:WINIFRED
Authorized Official - Middle Name:JEANETTE
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:515-962-9058
Mailing Address - Street 1:2812 COTTAGE GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50311-4010
Mailing Address - Country:US
Mailing Address - Phone:515-274-6351
Mailing Address - Fax:
Practice Address - Street 1:1007 S JEFFERSON WAY
Practice Address - Street 2:
Practice Address - City:INDIANOLA
Practice Address - State:IA
Practice Address - Zip Code:50125-3221
Practice Address - Country:US
Practice Address - Phone:515-962-9058
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00743101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA=========Medicaid