Provider Demographics
NPI:1669225157
Name:PURPLE CLOVER COUNSELING LLC
Entity type:Organization
Organization Name:PURPLE CLOVER COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARA
Authorized Official - Middle Name:
Authorized Official - Last Name:KAYSE
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:319-382-0918
Mailing Address - Street 1:260 33RD AVE SW STE X
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52404-4646
Mailing Address - Country:US
Mailing Address - Phone:319-382-0918
Mailing Address - Fax:
Practice Address - Street 1:260 33RD AVE SW STE X
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52404-4646
Practice Address - Country:US
Practice Address - Phone:319-382-0918
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)