Individual
MR. MARVIN FANGMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.A., IAADC
Contact information
Practice address
501 NORTH SHERMAN, PRAIRIE CITY, IA 50228
(515) 994-3562
(515) 994-3564
Mailing address
15806 WILDWOOD DRIVE, CLIVE, IA 50325
(515) 371-1166
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
10167
IA
104100000X
Social Worker
0-24094-1B
VI
1041C0700X
Clinical Social Worker
01546
IA
Other
Enumeration date
07/09/2015
Last updated
07/09/2015
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