Individual
MR. JOHN M SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSED, NCC, LMHC
Contact information
Practice address
933 E 53RD ST, DAVENPORT, IA 52808
(563) 324-9309
Mailing address
3125 DOUGLAS AVE STE 100, DES MOINES, IA 50310-5310
(563) 324-9309
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
001528
IA
Other
Enumeration date
10/23/2012
Last updated
09/25/2013
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