Provider Demographics
NPI:1023874229
Name:CHIC BEHAVIORAL HEALTH AND COMMUNITY SERVICES
Entity type:Organization
Organization Name:CHIC BEHAVIORAL HEALTH AND COMMUNITY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO AND FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-504-3186
Mailing Address - Street 1:3012 NW NORTHWOOD LN
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-1472
Mailing Address - Country:US
Mailing Address - Phone:319-504-3186
Mailing Address - Fax:
Practice Address - Street 1:3012 NW NORTHWOOD LN
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-1472
Practice Address - Country:US
Practice Address - Phone:319-504-3186
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty