Provider Demographics
NPI:1245088764
Name:CORALVILLE COUNSELING CENTER LLC
Entity type:Organization
Organization Name:CORALVILLE COUNSELING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CEO, THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:BOBBY JO
Authorized Official - Middle Name:
Authorized Official - Last Name:SALM
Authorized Official - Suffix:
Authorized Official - Credentials:LISW, RPT
Authorized Official - Phone:319-330-7227
Mailing Address - Street 1:860 22ND AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-1687
Mailing Address - Country:US
Mailing Address - Phone:319-330-7227
Mailing Address - Fax:
Practice Address - Street 1:860 22ND AVE STE 3
Practice Address - Street 2:
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-1687
Practice Address - Country:US
Practice Address - Phone:319-330-7227
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-09
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty