Provider Demographics
NPI:1649243403
Name:INSTITUTE FOR THERAPY AND PSYCHOLOGICAL SOLUTIONS L.L.C.
Entity type:Organization
Organization Name:INSTITUTE FOR THERAPY AND PSYCHOLOGICAL SOLUTIONS L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SECRIST
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LMFT
Authorized Official - Phone:515-465-5739
Mailing Address - Street 1:PO BOX 516
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:IA
Mailing Address - Zip Code:50220-0516
Mailing Address - Country:US
Mailing Address - Phone:515-465-5739
Mailing Address - Fax:515-465-5744
Practice Address - Street 1:410 12TH ST
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:IA
Practice Address - Zip Code:50220-7586
Practice Address - Country:US
Practice Address - Phone:515-465-5739
Practice Address - Fax:515-465-5744
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MID IOWA FAMILY THERAPY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-02-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0447631Medicaid
IA0740480Medicaid
IA1447631Medicaid
IA460178OtherVALUE OPTIONS
IA1447631Medicaid