Provider Demographics
NPI:1952925992
Name:JAN DUMOND LLC
Entity Type:Organization
Organization Name:JAN DUMOND LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DUMOND
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:309-507-0976
Mailing Address - Street 1:4620 E 53RD ST STE 264
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-3627
Mailing Address - Country:US
Mailing Address - Phone:563-293-7996
Mailing Address - Fax:563-562-0536
Practice Address - Street 1:4620 E 53RD ST STE 264
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-3627
Practice Address - Country:US
Practice Address - Phone:563-293-7996
Practice Address - Fax:563-562-0536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-05
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty