NPI 1093114191 · live from the CMS NPI Registry
Ardent Community Wellnes Center
Community/Behavioral Health in Fairfield, IA. National Provider Identifier 1093114191, active.
NPI record
| NPI | 1093114191 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Community/Behavioral Health 251S00000X |
| Practice location | 503 E Jefferson Ave, Fairfield, IA 52556 |
| Practice phone | 630-473-3091 |
| Mailing address | 684 S Barrington Rd, Suite 112, Streamwood, IL 60107 |
| Enumerated | August 14, 2014 |
| Last updated | August 14, 2014 |
| Authorized official | Stephen Baynes, Executive Director |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Counselor, Mental Health | 101YM0800X | — (IA) |
| Psychologist, Clinical | 103TC0700X | — (ID) |
| Social Worker, Clinical | 1041C0700X | — (IA) |
| Marriage & Family Therapist | 106H00000X | — (IA) |
| Community/Behavioral Health primary | 251S00000X | — (IA) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.