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1409 Clark St Des Moines IA 50314-1964 | |
| (515) 515-6434 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Adolescent And Children Mental Health |
| Location | 1409 Clark St, Des Moines, Iowa |
| Authorized Official Name and Position | Todd Beveridge (DIRECTOR) |
| Authorized Official Contact | 5152473265 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1409 Clark St Des Moines IA 50314-1964 Ph: (515) 515-6434 | 1409 Clark St Des Moines IA 50314-1964 Ph: (515) 515-6434 |
| NPI Number | 1649392325 |
|---|---|
| Provider Enumeration Date | 04/04/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649392325 | NPI | - | NPPES |
| 1102962 | Medicaid | IA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Primary |
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