Provider Demographics
NPI:1972859288
Name:NOBLE CEDAR PSYCHOLOGICAL INSTITUTE
Entity Type:Organization
Organization Name:NOBLE CEDAR PSYCHOLOGICAL INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER AND CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:GUEVARA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:319-883-9811
Mailing Address - Street 1:802 RAINBOW DR STE 1
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50701-1133
Mailing Address - Country:US
Mailing Address - Phone:319-883-9811
Mailing Address - Fax:319-883-9811
Practice Address - Street 1:1425 W. 5TH STREET
Practice Address - Street 2:SUITE 1
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50702
Practice Address - Country:US
Practice Address - Phone:319-883-9811
Practice Address - Fax:319-883-9811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-24
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001144103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty