Healthcare Provider Details

I. General information

NPI: 1639581150
Provider Name (Legal Business Name): CENTER CREEK COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2014
Last Update Date: 10/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

775 31 RD
FRANKLIN NE
68939-5158
US

IV. Provider business mailing address

775 31 RD
FRANKLIN NE
68939-5158
US

V. Phone/Fax

Practice location:
  • Phone: 308-470-1338
  • Fax: 308-425-3167
Mailing address:
  • Phone: 308-470-1338
  • Fax: 308-425-3167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1342
License Number StateNE

VIII. Authorized Official

Name: CHASTITY ANN INGRAM
Title or Position: OWNER/PROVIDER
Credential:
Phone: 308-470-1338