MEDICARE: COR THERAPEUTIC SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1437016136
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COR THERAPEUTIC SERVICES, LLC

Provider Business Mailing Address
First Line	:	120 W 2ND ST STE 3
Second Line	:
City	:	WAYNE
State	:	NE
Zip	:	68787-1957
Country	:	US
Telephone Number	:	402-500-6870
Fax Number	:	402-500-6871

Provider Business Practice Location Address
First Line	:	120 W 2ND ST STE 3
Second Line	:
City	:	WAYNE
State	:	NE
Zip	:	68787-1957
Country	:	US
Telephone Number	:	402-500-6870
Fax Number	:	402-500-6871

Authorized Official
Title or Position	:	BUSINESS MANAGER
Name	:	NICOLE E KETTLER
Credential	:
Telephone Number	:	402-500-6870

Provider Enumeration Date	:	01/06/2026
Last Update Date	:	03/06/2026

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Directions to “COR THERAPEUTIC SERVICES, LLC ” Practice Location

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