Provider Demographics
NPI:1487900965
Name:SEASONS CENTER FOR MENTAL HEALTH
Entity type:Organization
Organization Name:SEASONS CENTER FOR MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUBSTANCE ABUSE SERVICES SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENNA
Authorized Official - Middle Name:A
Authorized Official - Last Name:KOEDAM
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC, IADC
Authorized Official - Phone:800-242-5101
Mailing Address - Street 1:201 E 11TH ST
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:IA
Mailing Address - Zip Code:51301-4436
Mailing Address - Country:US
Mailing Address - Phone:800-242-5101
Mailing Address - Fax:712-264-3177
Practice Address - Street 1:201 E 11TH ST
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:IA
Practice Address - Zip Code:51301-4436
Practice Address - Country:US
Practice Address - Phone:800-242-5101
Practice Address - Fax:712-264-3177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-02
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001530101YM0800X
IA05041101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty