Organization
CHAMPION STATE OF MIND PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. AMANDA OLSON LMHC, NCC (OWNER)
(800) 592-0180
Entity
Organization
Contact information
Practice address
508 W CENTRAL AVE, STE B, ESTHERVILLE, IA 51334-1834
(800) 592-0180
(712) 566-5229
Mailing address
PO BOX 36, ESTHERVILLE, IA 51334-0036
(800) 592-0180
(712) 566-5229
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
001653
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1033578331
—
IA
Enumeration date
02/15/2016
Last updated
09/11/2018
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