Basic Information
| Provider Information | |||||||||
| NPI: | 1548776909 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MUSSON | ||||||||
| FirstName: | MADISON | ||||||||
| MiddleName: | ROSEANN RIDDLE | ||||||||
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| Credential: | M.A., ATR, LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3737 WOODLAND AVE STE 620 | ||||||||
| Address2: | |||||||||
| City: | WEST DES MOINES | ||||||||
| State: | IA | ||||||||
| PostalCode: | 502661937 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2065566118 | ||||||||
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| Practice Location | |||||||||
| Address1: | 600 42ND ST | ||||||||
| Address2: | |||||||||
| City: | DES MOINES | ||||||||
| State: | IA | ||||||||
| PostalCode: | 503122701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5152558399 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/21/2017 | ||||||||
| LastUpdateDate: | 06/17/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 106H00000X | 084849 | IA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.