Provider Demographics
NPI:1205439916
Name:EANES, INGA AYN (LMSW)
Entity type:Individual
Prefix:MS
First Name:INGA
Middle Name:AYN
Last Name:EANES
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:427 E KANESVILLE BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-9079
Mailing Address - Country:US
Mailing Address - Phone:712-256-9660
Mailing Address - Fax:712-256-9661
Practice Address - Street 1:427 E KANESVILLE BLVD STE 201
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-9079
Practice Address - Country:US
Practice Address - Phone:712-256-9660
Practice Address - Fax:712-256-9661
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA101267101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty