Provider Demographics
NPI:1962555003
Name:WOLFLEG COUNSELING
Entity type:Organization
Organization Name:WOLFLEG COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:319-936-6248
Mailing Address - Street 1:2871 HEINZ RD
Mailing Address - Street 2:STE 'B'
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52240-8196
Mailing Address - Country:US
Mailing Address - Phone:319-936-6248
Mailing Address - Fax:
Practice Address - Street 1:2871 HEINZ RD
Practice Address - Street 2:STE 'B'
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52240-8196
Practice Address - Country:US
Practice Address - Phone:319-936-6248
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-20
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02512101YM0800X, 101YP2500X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty