| Emerald Bridges Family Therapy, Llc | |
|
2349 Jamestown Ave Suite 5 Independence IA 50644-9709 | |
| (563) 579-1181 | |
| (319) 332-1241 |
| Full Name | Emerald Bridges Family Therapy, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 2349 Jamestown Ave, Independence, Iowa |
| Authorized Official Name and Position | Tara Nissen (MENTAL HEALTH THERAPIST) |
| Authorized Official Contact | 5635791181 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Emerald Bridges Family Therapy, Llc 914 Oregon St Waterloo IA 50702-2509 Ph: (563) 579-1181 | Emerald Bridges Family Therapy, Llc 2349 Jamestown Ave Suite 5 Independence IA 50644-9709 Ph: (563) 579-1181 |
| NPI Number | 1073966123 |
|---|---|
| Provider Enumeration Date | 07/13/2016 |
| Last Update Date | 07/13/2016 |
| Medicare PECOS PAC ID | 2264976828 |
|---|---|
| Medicare Enrollment ID | O20240708000616 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073966123 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 007613 (Iowa) | Primary |
| Provider Name | Tara Jean Bosnic |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1417258351 PECOS PAC ID: 3173067733 Enrollment ID: I20240708000659 |
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