Provider Demographics
NPI:1891147310
Name:AFFINITY THERAPY AND COUNSELING SERVICES
Entity Type:Organization
Organization Name:AFFINITY THERAPY AND COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-201-3446
Mailing Address - Street 1:9633 ENFIELD DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:IA
Mailing Address - Zip Code:50131-3081
Mailing Address - Country:US
Mailing Address - Phone:515-201-3446
Mailing Address - Fax:
Practice Address - Street 1:4910 URBANDALE AVE
Practice Address - Street 2:SUITE 305
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50310-2664
Practice Address - Country:US
Practice Address - Phone:515-201-3446
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-08
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty