Individual
CLINTON KEITH CUNNINGHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
405 MONROE ST, PELLA, IA 50219-1290
(641) 621-2200
(641) 621-2335
Mailing address
405 MONROE ST, PELLA, IA 50219-1290
(641) 621-2200
(641) 621-2335
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
087027
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
007829
IOWA LICENSE
IA
01
—
087027
IOWA LICENSE
IA
01
—
1215410741
NPI #
IA
01
—
LMFT-16160
OTHER
AZ
05
—
LMFT-16160
—
AZ
Enumeration date
09/11/2018
Last updated
10/13/2024
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