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515 Pacific Ave Audubon IA 50025-1056 | |
| (712) 563-5285 | |
| (833) 303-9139 |
| Full Name | |
|---|---|
| Speciality | Counselor |
| Location | 515 Pacific Ave, Audubon, Iowa |
| Authorized Official Name and Position | Lois Kay Potthoff (THERAPIST, DIRECTOR) |
| Authorized Official Contact | 7125635285 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
24144 215th St Carroll IA 51401-8647 Ph: (712) 830-6654 | 515 Pacific Ave Audubon IA 50025-1056 Ph: (712) 563-5285 |
| NPI Number | 1225805799 |
|---|---|
| Provider Enumeration Date | 12/05/2023 |
| Last Update Date | 12/02/2024 |
| Certification Date | 12/02/2024 |
| Medicare PECOS PAC ID | 0840735247 |
|---|---|
| Medicare Enrollment ID | O20240710001519 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225805799 | NPI | - | NPPES |
| 1750824934 | Other | IA | KEVIN REYNOLDS -NPI 1 |
| 1427422260 | Other | IA | THEA GUEST -NPI 1 |
| 0504297 | Medicaid | IA |
| Provider Name | Lois Kay Potthoff |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1811334519 PECOS PAC ID: 3476098880 Enrollment ID: I20240710001981 |
| Provider Name | Kevin James Reynolds |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1750824934 PECOS PAC ID: 8123563319 Enrollment ID: I20240711003820 |
| Provider Name | Thea Guest |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1427422260 PECOS PAC ID: 5496280927 Enrollment ID: I20241121000258 |