Basic Information
| Provider Information | |||||||||
| NPI: | 1275171688 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BINNEY | ||||||||
| FirstName: | NICOLE | ||||||||
| MiddleName: | KIMBERLY | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6200 AURORA AVE STE 305E | ||||||||
| Address2: | |||||||||
| City: | URBANDALE | ||||||||
| State: | IA | ||||||||
| PostalCode: | 503222863 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5157248920 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6200 AURORA AVE STE 305E | ||||||||
| Address2: | |||||||||
| City: | URBANDALE | ||||||||
| State: | IA | ||||||||
| PostalCode: | 503222863 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5157248920 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/16/2019 | ||||||||
| LastUpdateDate: | 12/16/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/16/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 098485 | IA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.