| Organization Name: | MID-IOWA FAMILY THERAPY CLINIC, INC. |
| NPI Number: | 1003999624 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CHRISTINE ANN SECRIST (ADMINISTRATOR) |
| Mailing Address: | 410 12th St Perry |
| State: | IA US |
| Postal Code: | 502207586 |
| Phone Number: | 5154655739 |
| Fax Number: | 5154655744 |
| NPI Enumeration Date: | 10/24/2006 |
| NPI Last Update Date: | 04/27/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |