Provider Demographics
NPI:1407627839
Name:DRIFTLESS COUNSELING LLC
Entity type:Organization
Organization Name:DRIFTLESS COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:BREITENSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:319-361-4248
Mailing Address - Street 1:3920 GLASS RD NE APT B
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-2508
Mailing Address - Country:US
Mailing Address - Phone:319-361-4248
Mailing Address - Fax:
Practice Address - Street 1:1111 PAINE ST STE L
Practice Address - Street 2:
Practice Address - City:DECORAH
Practice Address - State:IA
Practice Address - Zip Code:52101-2411
Practice Address - Country:US
Practice Address - Phone:319-361-4248
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-15
Last Update Date:2024-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty