Provider Demographics
NPI:1972119402
Name:POTENTIAL COUNSELING & CONSULTATION SERVICES LLC
Entity type:Organization
Organization Name:POTENTIAL COUNSELING & CONSULTATION SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER, THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:BROST
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:319-464-2389
Mailing Address - Street 1:320 DRYNAN DR
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50701-1622
Mailing Address - Country:US
Mailing Address - Phone:319-464-2389
Mailing Address - Fax:
Practice Address - Street 1:2800 ORCHARD DR STE B
Practice Address - Street 2:
Practice Address - City:CEDAR FALLS
Practice Address - State:IA
Practice Address - Zip Code:50613-5898
Practice Address - Country:US
Practice Address - Phone:319-464-2389
Practice Address - Fax:866-375-8530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-21
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty