Organization
GENESIS MENTAL HEALTH ASSOCIATES LLC
Active
Organization
GENESIS MENTAL HEALTH ASSOCIATES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LEANN MARIE RIDER-HILDRETH LISW (CLINICAL SOCIAL WORKER)
(515) 332-7167
Entity
Organization
Contact information
Practice address
1218 CENTRAL AVE, FORT DODGE, IA 50501-4246
(515) 571-4422
Mailing address
1218 CENTRAL AVE, FORT DODGE, IA 50501-4246
(515) 571-4422
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
01155
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1245298116
PERSONAL NPI
IA
Enumeration date
12/26/2006
Last updated
08/22/2020
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