Basic Information
| Provider Information | |||||||||
| NPI: | 1194496687 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RUNDLE | ||||||||
| FirstName: | BRIAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1400 34TH AVE SW APT 409 | ||||||||
| Address2: | |||||||||
| City: | ALTOONA | ||||||||
| State: | IA | ||||||||
| PostalCode: | 500095459 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6417777174 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6200 AURORA AVE STE 401E | ||||||||
| Address2: | |||||||||
| City: | URBANDALE | ||||||||
| State: | IA | ||||||||
| PostalCode: | 503222866 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5153310303 | ||||||||
| FaxNumber: | 5153319086 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2021 | ||||||||
| LastUpdateDate: | 09/23/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 108305 | IA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.