MEDICARE: BETH JEANNINE CROSTON LMHP, CCGC

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	3342	NE
2	101Y00000X	Counselor	38	NE

General Provider Information

NPI Number	:	1629060777
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETH JEANNINE CROSTON LMHP, CCGC

Provider Business Mailing Address
First Line	:	4920 S 30TH ST
Second Line	:	SUITE 103
City	:	OMAHA
State	:	NE
Zip	:	68107-1590
Country	:	US
Telephone Number	:	402-502-8961
Fax Number	:	402-991-5642

Provider Business Practice Location Address
First Line	:	4920 S 30TH ST
Second Line	:	SUITE 103
City	:	OMAHA
State	:	NE
Zip	:	68107-1590
Country	:	US
Telephone Number	:	402-502-8961
Fax Number	:	402-991-5642

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2005
Last Update Date	:	04/02/2025

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