Provider Demographics
NPI:1942633417
Name:TOWNCLOCK MENTAL HEALTH PC
Entity type:Organization
Organization Name:TOWNCLOCK MENTAL HEALTH PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPLE, PRACTITIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:LIGHTCAP
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:563-583-5627
Mailing Address - Street 1:799 MAIN ST
Mailing Address - Street 2:STE 370
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-6844
Mailing Address - Country:US
Mailing Address - Phone:563-583-4111
Mailing Address - Fax:563-583-5666
Practice Address - Street 1:799 MAIN ST
Practice Address - Street 2:STE 370
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-6844
Practice Address - Country:US
Practice Address - Phone:563-583-4111
Practice Address - Fax:563-583-5666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-19
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00716101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty