Basic Information
| Provider Information | |||||||||
| NPI: | 1104064153 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EMERSON | ||||||||
| FirstName: | RYAN | ||||||||
| MiddleName: | JOEL | ||||||||
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| Credential: | LMHC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1123 1ST AVE E | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | NEWTON | ||||||||
| State: | IA | ||||||||
| PostalCode: | 502083914 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6417924012 | ||||||||
| FaxNumber: | 6417910697 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 4TH AVE W | ||||||||
| Address2: | |||||||||
| City: | GRINNELL | ||||||||
| State: | IA | ||||||||
| PostalCode: | 501121833 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6415286065 | ||||||||
| FaxNumber: | 6412608269 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2009 | ||||||||
| LastUpdateDate: | 02/25/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 074580 | IA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.