Provider Demographics
NPI:1528505369
Name:CEDAR VALLEY COUNSELING SERVICES
Entity type:Organization
Organization Name:CEDAR VALLEY COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:DONAVON
Authorized Official - Last Name:SCHAEFER
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:319-239-3533
Mailing Address - Street 1:PO BOX 485
Mailing Address - Street 2:
Mailing Address - City:CEDAR FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50613-0026
Mailing Address - Country:US
Mailing Address - Phone:319-239-3533
Mailing Address - Fax:
Practice Address - Street 1:4521 CHADWICK RD
Practice Address - Street 2:SUITE 2
Practice Address - City:CEDAR FALLS
Practice Address - State:IA
Practice Address - Zip Code:50613-8045
Practice Address - Country:US
Practice Address - Phone:319-239-3533
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-31
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001292101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty