Organization
EMERALD BRIDGES FAMILY THERAPY, LLC
Active
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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