| Wild Spirit Counseling, Llc | |
|
15 E Southridge Rd Marshalltown IA 50158-4550 | |
| (641) 351-4003 | |
| (641) 243-2115 |
| Full Name | Wild Spirit Counseling, Llc |
|---|---|
| Speciality | Counselor |
| Location | 15 E Southridge Rd, Marshalltown, Iowa |
| Authorized Official Name and Position | Misty Lynn Smith (THERAPIST) |
| Authorized Official Contact | 6413514003 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wild Spirit Counseling, Llc 15 E Southridge Rd Marshalltown IA 50158-4550 Ph: (641) 351-4003 | Wild Spirit Counseling, Llc 15 E Southridge Rd Marshalltown IA 50158-4550 Ph: (641) 351-4003 |
| NPI Number | 1609518810 |
|---|---|
| Provider Enumeration Date | 04/08/2022 |
| Last Update Date | 10/20/2022 |
| Certification Date | 10/20/2022 |
| Medicare PECOS PAC ID | 4284075235 |
|---|---|
| Medicare Enrollment ID | O20240508003500 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609518810 | NPI | - | NPPES |
| 1154742989 | Other | IA | INDIVIDUAL NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Misty Lynn Smith |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1154742989 PECOS PAC ID: 5193166148 Enrollment ID: I20240508003595 |
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