Organization
THE LODGE COUNSELING & CONSULITING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. VINCENT MAHON (CO-OWNER)
(712) 259-5134
Entity
Organization
Contact information
Practice address
705 DOUGLAS ST, SUITE # 208, SIOUX CITY, IA 51101-1048
(712) 259-5134
Mailing address
705 DOUGLAS ST, SUITE # 208, SIOUX CITY, IA 51101-1048
(712) 259-5134
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
1041C0700X
Clinical Social Worker
—
—
Other
Enumeration date
09/01/2011
Last updated
09/01/2011
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