Provider Demographics
NPI:1457129991
Name:INTERCONNECTIONS THERAPY LLC
Entity Type:Organization
Organization Name:INTERCONNECTIONS THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:TEN NAPEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-754-2400
Mailing Address - Street 1:115 CEDAR LN STE B
Mailing Address - Street 2:
Mailing Address - City:SIBLEY
Mailing Address - State:IA
Mailing Address - Zip Code:51249-1013
Mailing Address - Country:US
Mailing Address - Phone:712-754-2400
Mailing Address - Fax:
Practice Address - Street 1:115 CEDAR LN STE B
Practice Address - Street 2:
Practice Address - City:SIBLEY
Practice Address - State:IA
Practice Address - Zip Code:51249-1013
Practice Address - Country:US
Practice Address - Phone:712-754-2400
Practice Address - Fax:712-754-4612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-14
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2223815Medicaid