NPIMap

Organization Active NPI

Self

  • Community/Behavioral Health Agency
  • Glenwood, IA
National Provider Identifier
1508319666
Registry record updated Jul 25, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
10764 Issued in NE
Legal business name
SELF
Practice address
117 Valley St
Glenwood, IA 51534-1024
Phone
(712) 527-1064
NPI assigned
Jul 25, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2016

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

Authorized official

Name
Miss Susan Dawn Mayberry, PLMHPNPI 1861946071
Title
Therapist
Phone
(712) 527-1064

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
Community/Behavioral Health Agency 251S00000X 10764 NE Primary

Addresses

Primary practice location

117 Valley St
Glenwood, IA 51534-1024

Mailing address

117 Valley St
Glenwood, IA 51534-1024
Phone (712) 527-1064

National Provider Directory

National Provider Directory
Tax ID family
Kaiser Permanente Panorama City Medical Center119 organizations share this tax ID, including this one

Practitioners & affiliated clinicians

Practitioners 1

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": "1469404800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1469404800000",
    "number": "1508319666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "117 VALLEY ST",
            "city": "GLENWOOD",
            "state": "IA",
            "postal_code": "515341024",
            "telephone_number": "712-527-1064"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "117 VALLEY ST",
            "city": "GLENWOOD",
            "state": "IA",
            "postal_code": "515341024",
            "telephone_number": "712-527-1064"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SELF",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-25",
        "last_updated": "2016-07-25",
        "status": "A",
        "authorized_official_last_name": "MAYBERRY",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "DAWN",
        "authorized_official_title_or_position": "THERAPIST",
        "authorized_official_telephone_number": "712-527-1064",
        "authorized_official_name_prefix": "Miss",
        "authorized_official_credential": "PLMHP"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NE",
            "license": "10764",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glenwood, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2016; 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.