Healthcare Provider Details

I. General information

NPI: 1972683282
Provider Name (Legal Business Name): CYCLETHERAPY COUNSELING SERVICES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 10/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42534 HIGHWAY 23
ELWOOD NE
68937-5632
US

IV. Provider business mailing address

42534 HIGHWAY 23
ELWOOD NE
68937-5632
US

V. Phone/Fax

Practice location:
  • Phone: 308-785-2064
  • Fax:
Mailing address:
  • Phone: 308-785-2064
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1742
License Number StateNE

VIII. Authorized Official

Name: MR. DAVID C BLESSING
Title or Position: PRESIDENT
Credential: MS, LMHP, LPC
Phone: 308-785-2064