Provider Demographics
NPI:1912247909
Name:RATH, BRIAN R (LMHC)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:R
Last Name:RATH
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3005 OLD CAPTAINS RD
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:IA
Mailing Address - Zip Code:52327-9060
Mailing Address - Country:US
Mailing Address - Phone:319-930-0678
Mailing Address - Fax:
Practice Address - Street 1:1519 S GILBERT ST
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52240-4367
Practice Address - Country:US
Practice Address - Phone:319-338-9212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-27
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001603101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health