Provider Demographics
NPI:1992203061
Name:PRAIRIE HOME WELLNESS AND COUNSELING
Entity Type:Organization
Organization Name:PRAIRIE HOME WELLNESS AND COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:WELTER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:319-480-9694
Mailing Address - Street 1:218 W 1ST ST STE A
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:IA
Mailing Address - Zip Code:52310-1401
Mailing Address - Country:US
Mailing Address - Phone:319-975-8705
Mailing Address - Fax:
Practice Address - Street 1:218 W 1ST ST STE A
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:IA
Practice Address - Zip Code:52310-1401
Practice Address - Country:US
Practice Address - Phone:319-975-8705
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-24
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA079523261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)