Provider Demographics
NPI:1528166360
Name:POWESHIEK COUNTY MENTAL HEALTH CENTER
Entity type:Organization
Organization Name:POWESHIEK COUNTY MENTAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MYKE
Authorized Official - Middle Name:
Authorized Official - Last Name:SELHA
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:641-236-6137
Mailing Address - Street 1:200 4TH AVE WEST
Mailing Address - Street 2:
Mailing Address - City:GRINNELL
Mailing Address - State:IA
Mailing Address - Zip Code:50112
Mailing Address - Country:US
Mailing Address - Phone:641-236-6137
Mailing Address - Fax:641-236-0206
Practice Address - Street 1:200 4TH AVE WEST
Practice Address - Street 2:
Practice Address - City:GRINNELL
Practice Address - State:IA
Practice Address - Zip Code:50112
Practice Address - Country:US
Practice Address - Phone:641-236-6137
Practice Address - Fax:641-236-0206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0069468Medicaid
IA06946OtherWELLMARK BCBS
IA0069468Medicaid