Clinton Keith Cunningham, | |
405 Monroe St, Pella, IA 50219-1290 | |
(641) 621-2200 | |
(641) 621-2335 |
Full Name | Clinton Keith Cunningham |
---|---|
Gender | Male |
Speciality | Marriage & Family Therapist |
Location | 405 Monroe St, Pella, Iowa |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1215410741 | NPI | - | NPPES |
1215410741 | Other | IA | NPI # |
LMFT-16160 | Other | AZ | OTHER |
LMFT-16160 | Medicaid | AZ | |
007829 | Other | IA | IOWA LICENSE |
087027 | Other | IA | IOWA LICENSE |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
106H00000X | Marriage & Family Therapist | 087027 (Iowa) | Primary |
Entity Name | Pella Regional Health Center |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1053369405 PECOS PAC ID: 9931005873 Enrollment ID: O20031210000914 |
Mailing Address | Practice Location Address |
---|---|
Clinton Keith Cunningham, 405 Monroe St, Pella, IA 50219-1290 Ph: (641) 621-2200 | Clinton Keith Cunningham, 405 Monroe St, Pella, IA 50219-1290 Ph: (641) 621-2200 |
Mrs. Darla Joy De Haan, MA Couples Therapy Medicare: Not Enrolled in Medicare Practice Location: 315 Main St, Pella, IA 50219 Phone: 641-628-1723 Fax: 641-628-1723 | |
Mr. Matthew Joseph Burch, M.A. Couples Therapy Medicare: Not Enrolled in Medicare Practice Location: 315 Main St, Pella, IA 50219 Phone: 641-628-1723 Fax: 641-628-1723 | |
Joseph Thomas Graybill, Couples Therapy Medicare: Not Enrolled in Medicare Practice Location: 315 Main St, Pella, IA 50219 Phone: 641-628-1723 |