Provider Demographics
NPI:1154800456
Name:CHELYNE J. CUNNINGHAM COUNSELING, INC.
Entity type:Organization
Organization Name:CHELYNE J. CUNNINGHAM COUNSELING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHELYNE
Authorized Official - Middle Name:JEANETTE
Authorized Official - Last Name:CUNNINGHAM-SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:515-221-1989
Mailing Address - Street 1:100 7TH AVENUE CT NE
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:IA
Mailing Address - Zip Code:50009-1937
Mailing Address - Country:US
Mailing Address - Phone:319-321-4473
Mailing Address - Fax:
Practice Address - Street 1:939 OFFICE PARK RD STE 103
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50265-2505
Practice Address - Country:US
Practice Address - Phone:515-221-1989
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-08
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA006960261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1659541126Medicaid