Provider Demographics
NPI:1063586840
Name:AMELSBERG, JAMES E (LSW, LMHC)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:E
Last Name:AMELSBERG
Suffix:
Gender:M
Credentials:LSW, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 N CLARK ST STE B
Mailing Address - Street 2:PO BOX 333
Mailing Address - City:FOREST CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50436-1615
Mailing Address - Country:US
Mailing Address - Phone:641-585-3575
Mailing Address - Fax:641-585-1780
Practice Address - Street 1:101 N CLARK ST STE B
Practice Address - Street 2:
Practice Address - City:FOREST CITY
Practice Address - State:IA
Practice Address - Zip Code:50436-1615
Practice Address - Country:US
Practice Address - Phone:641-585-3575
Practice Address - Fax:641-585-1780
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00265101YM0800X
IA20321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical