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605 Lake St Ste 5 Spirit Lake IA 51360-1674 | |
| (712) 320-0202 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 605 Lake St Ste 5, Spirit Lake, Iowa |
| Authorized Official Name and Position | Joey Leigh Gude (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 7123200202 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
1451 210th Ave Spirit Lake IA 51360-7566 Ph: (712) 320-0202 | 605 Lake St Ste 5 Spirit Lake IA 51360-1674 Ph: (712) 320-0202 |
| NPI Number | 1861977506 |
|---|---|
| Provider Enumeration Date | 09/28/2018 |
| Last Update Date | 09/18/2024 |
| Certification Date | 09/18/2024 |
| Medicare PECOS PAC ID | 1759813587 |
|---|---|
| Medicare Enrollment ID | O20241017000952 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861977506 | NPI | - | NPPES |
| Provider Name | Joey Leigh Gude |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1295182368 PECOS PAC ID: 2668904491 Enrollment ID: I20241017001193 |
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