Organization
SELF-ALIGNMENT EVALUATION AND OUTPATIENT TREATMENT SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEROME MILLER M.S., (T)LMHC, IADC (EXECUTIVE DIRECTOR/COUNSELOR)
(515) 865-7783
Entity
Organization
Contact information
Practice address
100 E EUCLID AVE STE 157, DES MOINES, IA 50313-4583
(515) 868-1818
Mailing address
100 E EUCLID AVE STE 157, DES MOINES, IA 50313-4583
(515) 868-1818
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
284UU5368
DRIVER'S LICENSE NUMBER
IA
Enumeration date
08/16/2022
Last updated
08/16/2022
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