NPIMap

Organization Active NPI

Full Circle Therapy Center, LLC

  • Mental Health Counselor
  • Council Bluffs, IA
National Provider Identifier
1710270087
Registry record updated Aug 7, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
001148 Issued in IA
Legal business name
FULL CIRCLE THERAPY CENTER, LLC
Practice address
803 3Rd Ave
Council Bluffs, IA 51501
Phone
(402) 210-6507
NPI assigned
May 19, 2011
Last updated
Aug 7, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 7, 2019

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

Authorized official

Name
Kami GuzmanNPI 1700033602
Title
Co-Owner
Phone
(712) 352-0917

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X 001148 IA Primary
Behavior AnalystGroup: 193200000X MULTI-SPECIALTY GROUP 103K00000X
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X

Addresses

Primary practice location

803 3Rd Ave
Council Bluffs, IA 51501

Mailing address

803 3Rd Ave
Council Bluffs, IA 51501
Phone (402) 210-6507

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190108001446 IA Part B Supplier - Clinic/Group Practice 0648516963 Receives reassigned benefits from 1 practitioner
Practice locations: Council Bluffs, IA

National Provider Directory

National Provider Directory

Locations

312 W 3rd St
Carroll, IA 51401
Phone (712) 352-0917

803 3rd Ave
Council Bluffs, IA 51501
Phone (712) 352-0917

4685 Merle Hay Rd
Ste 205
Des Moines, IA 50322
Phone (217) 352-0917

111 N 2nd Ave
Winterset, IA 50273
Phone (712) 352-0917

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1305763200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1565136000000",
    "number": "1710270087",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "803 3RD AVE",
            "city": "COUNCIL BLUFFS",
            "state": "IA",
            "postal_code": "51501",
            "telephone_number": "402-210-6507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "803 3RD AVE",
            "city": "COUNCIL BLUFFS",
            "state": "IA",
            "postal_code": "51501",
            "telephone_number": "402-210-6507"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FULL CIRCLE THERAPY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-19",
        "last_updated": "2019-08-07",
        "status": "A",
        "authorized_official_last_name": "GUZMAN",
        "authorized_official_first_name": "KAMI",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "712-352-0917"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "IA",
            "license": "001148",
            "primary": true
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Council Bluffs, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.