Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | 074108 | IA |
NPI | 1003215286 |
---|---|
Provider Name | Zifa Hackett |
First Address | Des Moines, IA 50309-1307 |
Second Address | Des Moines, IA 50309-1307 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2014 |
Last Update Date | 14/08/2014 |