Organization
EMERALD BRIDGES FAMILY THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TARA NISSEN LISW (MENTAL HEALTH THERAPIST)
(563) 579-1181
Entity
Organization
Contact information
Practice address
2349 JAMESTOWN AVE, SUITE 5, INDEPENDENCE, IA 50644-9709
(563) 579-1181
(319) 332-1241
Mailing address
914 OREGON ST, WATERLOO, IA 50702-2509
(563) 579-1181
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
007613
IA
Other
Enumeration date
07/13/2016
Last updated
07/13/2016
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