Provider Demographics
NPI:1942251160
Name:CENTER ASSOCIATES
Entity Type:Organization
Organization Name:CENTER ASSOCIATES
Other - Org Name:MENTAL HEALTH CENTER OF MID-IOWA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO/LICENSED PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:J. MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BERGMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LICENSED PSYCHOLOGIS
Authorized Official - Phone:641-752-1585
Mailing Address - Street 1:404 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:MARSHALLTOWN
Mailing Address - State:IA
Mailing Address - Zip Code:50158-5517
Mailing Address - Country:US
Mailing Address - Phone:641-752-5933
Mailing Address - Fax:
Practice Address - Street 1:9 N 4TH AVE
Practice Address - Street 2:
Practice Address - City:MARSHALLTOWN
Practice Address - State:IA
Practice Address - Zip Code:50158-1836
Practice Address - Country:US
Practice Address - Phone:641-752-1585
Practice Address - Fax:641-752-9665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00505103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA05823OtherBCBS
IA0058230Medicaid
IA0058230Medicaid