| Empowering Grounds Llc | |
|
531 S 29th St Ste 1 Fort Dodge IA 50501-5503 | |
| (515) 576-9376 | |
| Not Available |
| Full Name | Empowering Grounds Llc |
|---|---|
| Speciality | Counselor |
| Location | 531 S 29th St Ste 1, Fort Dodge, Iowa |
| Authorized Official Name and Position | Roxanne Fevold (LMHC/OWNER) |
| Authorized Official Contact | 5155769376 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Empowering Grounds Llc Po Box 2400 Waterloo IA 50704-2400 Ph: () - | Empowering Grounds Llc 531 S 29th St Ste 1 Fort Dodge IA 50501-5503 Ph: (515) 576-9376 |
| NPI Number | 1093310708 |
|---|---|
| Provider Enumeration Date | 12/01/2020 |
| Last Update Date | 12/15/2020 |
| Certification Date | 12/15/2020 |
| Medicare PECOS PAC ID | 3476966482 |
|---|---|
| Medicare Enrollment ID | O20210113000247 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093310708 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Kirsten J Olson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1780956094 PECOS PAC ID: 4183945603 Enrollment ID: I20150609000647 |
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