| Self | |
|
117 Valley St Glenwood IA 51534-1024 | |
| (712) 527-1064 | |
| Not Available |
| Full Name | Self |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 117 Valley St, Glenwood, Iowa |
| Authorized Official Name and Position | Susan Dawn Mayberry (THERAPIST) |
| Authorized Official Contact | 7125271064 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Self 117 Valley St Glenwood IA 51534-1024 Ph: (712) 527-1064 | Self 117 Valley St Glenwood IA 51534-1024 Ph: (712) 527-1064 |
| NPI Number | 1508319666 |
|---|---|
| Provider Enumeration Date | 07/25/2016 |
| Last Update Date | 07/25/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508319666 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 10764 (Nebraska) | Primary |
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