Healthcare Provider Details

I. General information

NPI: 1922519206
Provider Name (Legal Business Name): STACI HUSTON PCP, LIMHP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2017
Last Update Date: 12/13/2024
Certification Date: 12/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2740 N CLARKSON ST
FREMONT NE
68025-7702
US

IV. Provider business mailing address

4321 41ST AVE
COLUMBUS NE
68601-2131
US

V. Phone/Fax

Practice location:
  • Phone: 402-721-0951
  • Fax: 402-564-0611
Mailing address:
  • Phone: 402-562-8955
  • Fax: 402-564-0611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2933
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: