Provider Demographics
NPI:1295271856
Name:DOLLEN, LINDA KAY (MS, NCC, MHC)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:KAY
Last Name:DOLLEN
Suffix:
Gender:F
Credentials:MS, NCC, MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2999 WICHITA AVE
Mailing Address - Street 2:
Mailing Address - City:PERSIA
Mailing Address - State:IA
Mailing Address - Zip Code:51563-4070
Mailing Address - Country:US
Mailing Address - Phone:712-216-0523
Mailing Address - Fax:
Practice Address - Street 1:427 E KANESVILLE BLVD STE 102
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-4403
Practice Address - Country:US
Practice Address - Phone:712-256-9660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-06
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA073540101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health