# KANESVILLE THERAPY LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1760668768
- **Authorized official:** MRS. CAROLYN ANN ANDERSEN BURGHER MS LMHC LMHP LIMHP (MENTAL HEALTH COUNSELOR)
- **Authorized official phone:** (712) 328-9205

## Contact information

- **Practice address:** 35 MAIN PLACE, SUITE 100 OMNI CENTER BUSINESS PARK, COUNCIL BLUFFS, IA 51503
- **Practice address phone:** (712) 328-9205
- **Mailing address:** 16 LOCUST LODGE, COUNCIL BLUFFS, IA 51503
- **Mailing address phone:** (712) 328-9205

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YM0800X | Mental Health Counselor | 00169 | IA | Yes |
| 101YM0800X | Mental Health Counselor | 1750 | NE | — |
| 101YM0800X | Mental Health Counselor | 376 | NE | — |

## Other

- **Enumeration date:** 01/21/2008
- **Last updated:** 04/28/2008