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515 E Broadway Council Bluffs IA 51503 | |
| (712) 322-1407 | |
| (712) 322-6833 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 515 E Broadway, Council Bluffs, Iowa |
| Authorized Official Name and Position | John Jeanetta (PRESIDENT CEO) |
| Authorized Official Contact | 4025527402 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
2101 S 42nd St Omaha NE 68105-2909 Ph: (402) 553-3000 | 515 E Broadway Council Bluffs IA 51503 Ph: (712) 322-1407 |
| NPI Number | 1316009475 |
|---|---|
| Provider Enumeration Date | 12/15/2006 |
| Last Update Date | 09/01/2010 |
| Medicare PECOS PAC ID | 7315833506 |
|---|---|
| Medicare Enrollment ID | O20081218000069 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316009475 | NPI | - | NPPES |
| Provider Name | Dianna Prokupek |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194797449 PECOS PAC ID: 8628013588 Enrollment ID: I20050622000538 |
| Provider Name | Michael Lee Coy |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1124152780 PECOS PAC ID: 4082655055 Enrollment ID: I20080508000770 |
| Provider Name | Terry M Ideker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326227224 PECOS PAC ID: 2264590843 Enrollment ID: I20090327000300 |
| Provider Name | David B Walker |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1003004391 PECOS PAC ID: 6305000993 Enrollment ID: I20120612000130 |
| Provider Name | Shelli J Reams |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1841641230 PECOS PAC ID: 5193150993 Enrollment ID: I20200125000156 |
| Provider Name | Lauren A Campbell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1225568793 PECOS PAC ID: 9133555410 Enrollment ID: I20200205000138 |
| Provider Name | Kaitlin Carlson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1780167676 PECOS PAC ID: 7911395900 Enrollment ID: I20211025000798 |
| Provider Name | Alfred Ongesa |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013688530 PECOS PAC ID: 2163810151 Enrollment ID: I20211025000953 |
| Provider Name | Karen Baber |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1831813674 PECOS PAC ID: 0547638959 Enrollment ID: I20221116000434 |
| Provider Name | Gerardo Guerrero-segura |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417637893 PECOS PAC ID: 0446613103 Enrollment ID: I20230828003342 |
| Provider Name | Jessica Stallings |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1811262314 PECOS PAC ID: 6002349214 Enrollment ID: I20241026000172 |
| Provider Name | Lindsey Hylen |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1083225999 PECOS PAC ID: 1355874579 Enrollment ID: I20241028000172 |
| Provider Name | Suzanne Barrett-mcclendon |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1841282928 PECOS PAC ID: 9537692686 Enrollment ID: I20241028001464 |
| Provider Name | Peg Eppolito |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1467827212 PECOS PAC ID: 2860925856 Enrollment ID: I20241029004310 |
| Provider Name | Daniel Messina |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1427215995 PECOS PAC ID: 5294268223 Enrollment ID: I20241030001045 |
| Provider Name | Mindy Blair |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1952773962 PECOS PAC ID: 9537692561 Enrollment ID: I20241030001180 |
| Provider Name | Angela Halstead |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1861175705 PECOS PAC ID: 8224477039 Enrollment ID: I20241112001840 |
Thurman Psychological Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 427 E Kanesville Blvd, Suite #406, Council Bluffs, IA 51503 Phone: 402-715-4321 Fax: 402-715-4343 | |
Visinet Of Iowa, Inc. Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 523 S Main St, Council Bluffs, IA 51503 Phone: 712-322-7800 | |
A Place For Grace Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 11 S 1st St, Council Bluffs, IA 51503 Phone: 515-620-3284 | |
Heartland Family Service Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1722 Ave C, Council Bluffs, IA 51501 Phone: 712-435-5380 | |
Embrace Wellness Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 254 Elmwood Dr, Council Bluffs, IA 51503 Phone: 402-979-6150 | |
The Inroads Foundation Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 933 E Pierce St, Council Bluffs, IA 51503 Phone: 402-932-2248 Fax: 402-932-3557 | |
Cross Therapy Center Pllc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 20 Frank St, Council Bluffs, IA 51503 Phone: 712-256-9000 Fax: 712-256-7710 |