Healthcare Provider Details

I. General information

NPI: 1962668491
Provider Name (Legal Business Name): MENTAL HEALTH CARE ASSOC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2008
Last Update Date: 08/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

343 CHADRON AVE
CHADRON NE
69337
US

IV. Provider business mailing address

343 CHADRON AVE
CHADRON NE
69337
US

V. Phone/Fax

Practice location:
  • Phone: 308-432-2133
  • Fax: 308-432-2133
Mailing address:
  • Phone: 308-432-2133
  • Fax: 308-432-2133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number412
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number38
License Number StateNE
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number378
License Number StateNE

VIII. Authorized Official

Name: DR. LORRAINE I MILES
Title or Position: OWNER
Credential: PHD
Phone: 308-432-2133