Basic Information
| Provider Information | |||||||||
| NPI: | 1861485492 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FRANKLIN | ||||||||
| FirstName: | RAY | ||||||||
| MiddleName: | LEO | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | LISW | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | FRANKLIN | ||||||||
| OtherFirstName: | RAYMOND | ||||||||
| OtherMiddleName: | LEO | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 306 N 3RD AVE E | ||||||||
| Address2: | |||||||||
| City: | NEWTON | ||||||||
| State: | IA | ||||||||
| PostalCode: | 502083249 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6417924012 | ||||||||
| FaxNumber: | 6417910697 | ||||||||
| Practice Location | |||||||||
| Address1: | 701 RIVERVIEW ST | ||||||||
| Address2: | |||||||||
| City: | DES MOINES | ||||||||
| State: | IA | ||||||||
| PostalCode: | 503162343 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8889486789 | ||||||||
| FaxNumber: | 8773453501 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2005 | ||||||||
| LastUpdateDate: | 02/18/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
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| AuthorizedOfficialNameSuffix: | |||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 05132 | IA | N | Behavioral Health & Social Service Providers | Social Worker | 1041C0700X | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 420681060C9 | 01 | IA | JOHN DEERE HEALTH | OTHER | 25848 | 01 | IA | WELLMARK INC BCBS | OTHER | 420681060C9 | 01 | IA | UNITED BEHAVIORAL HEALTH | OTHER | I018 | 01 | IA | TRIWEST | OTHER |