Provider Demographics
NPI:1366065062
Name:THEA BEDELL, LMHC, LLC
Entity type:Organization
Organization Name:THEA BEDELL, LMHC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:THEA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BEDELL
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:319-480-4055
Mailing Address - Street 1:3412 CENTER POINT RD NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-5529
Mailing Address - Country:US
Mailing Address - Phone:319-480-4055
Mailing Address - Fax:319-382-8693
Practice Address - Street 1:3412 CENTER POINT RD NE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-5529
Practice Address - Country:US
Practice Address - Phone:319-480-4055
Practice Address - Fax:319-382-8693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-28
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty