NPIMap

Organization Active NPI

Champion State of Mind PLLC

  • Mental Health Counselor
  • Estherville, IA
National Provider Identifier
1033578331
Registry record updated Sep 11, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
001653 Issued in IA
Legal business name
CHAMPION STATE OF MIND PLLC
Practice address
508 W Central Ave
Ste B
Estherville, IA 51334-1834
Phone
(800) 592-0180
Fax
(712) 566-5229
NPI assigned
Feb 15, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Amanda Olson, LMHC, NCCNPI 1558794099
Title
Owner
Phone
(800) 592-0180

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101YM0800X 001653 IA Primary

Addresses

Primary practice location

508 W Central Ave
Ste B
Estherville, IA 51334-1834

Mailing address

PO Box 36
Estherville, IA 51334-0036
Phone (800) 592-0180

Other identifiers 1

IdentifierTypeStateIssuer
1033578331MedicaidIA

National Provider Directory

National Provider Directory

Locations

109 S 17th St
Estherville, IA 51334

508 W Central Ave
Ste B
Estherville, IA 51334
Phone (712) 362-2404

1430 1st Ave S
Estherville, IA 51334

1520 Central Ave
Estherville, IA 51334

508 W Central Ave
Estherville, IA 51334
Phone (712) 362-2461

215 4th Ave SE
Le Mars, IA 51031

901 H Ave
Milford, IA 51351

910 10th St
Milford, IA 51351
Phone (712) 338-6200

703 16th St
Spirit Lake, IA 51360

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1455494400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1536624000000",
    "number": "1033578331",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 36",
            "city": "ESTHERVILLE",
            "state": "IA",
            "postal_code": "513340036",
            "telephone_number": "800-592-0180",
            "fax_number": "712-566-5229"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "508 W CENTRAL AVE",
            "address_2": "STE B",
            "city": "ESTHERVILLE",
            "state": "IA",
            "postal_code": "513341834",
            "telephone_number": "800-592-0180",
            "fax_number": "712-566-5229"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHAMPION STATE OF MIND PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-15",
        "last_updated": "2018-09-11",
        "status": "A",
        "authorized_official_last_name": "OLSON",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "800-592-0180",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LMHC, NCC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": "IA",
            "license": "001653",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1033578331",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Estherville, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.