Provider Demographics
NPI:1144695040
Name:MIDWEST MENTAL HEALTH LLC
Entity type:Organization
Organization Name:MIDWEST MENTAL HEALTH LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:KINDRA
Authorized Official - Middle Name:ANISA
Authorized Official - Last Name:WESTON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LMHC, NCC
Authorized Official - Phone:712-350-3771
Mailing Address - Street 1:PO BOX 115
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH
Mailing Address - State:IA
Mailing Address - Zip Code:51601-0115
Mailing Address - Country:US
Mailing Address - Phone:712-246-0159
Mailing Address - Fax:
Practice Address - Street 1:523 W SHERIDAN AVE
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:IA
Practice Address - Zip Code:51601-1705
Practice Address - Country:US
Practice Address - Phone:712-246-0159
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-03
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA077004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty