Provider Demographics
NPI:1427422260
Name:GUEST, THEA (LMSW)
Entity type:Individual
Prefix:
First Name:THEA
Middle Name:
Last Name:GUEST
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:AUDUBON
Mailing Address - State:IA
Mailing Address - Zip Code:50025-1056
Mailing Address - Country:US
Mailing Address - Phone:515-992-0511
Mailing Address - Fax:
Practice Address - Street 1:23751 HIGHWAY 30
Practice Address - Street 2:
Practice Address - City:CARROLL
Practice Address - State:IA
Practice Address - Zip Code:51401-8505
Practice Address - Country:US
Practice Address - Phone:712-792-9266
Practice Address - Fax:712-792-1457
Is Sole Proprietor?:No
Enumeration Date:2015-11-17
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
IA0746091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical