Individual
JACK FORMANEK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS, LMHP
Contact information
Practice address
307 E VIEW DR, COUNCIL BLUFFS, IA 51503-0464
(712) 325-1584
(712) 325-0546
Mailing address
307 E VIEW DR, COUNCIL BLUFFS, IA 51503-0464
(712) 325-1584
(712) 325-0546
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
205
IA
Other
Enumeration date
01/02/2007
Last updated
07/08/2007
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