Healthcare Provider Details

I. General information

NPI: 1790558054
Provider Name (Legal Business Name): CENTRAL NEBRASKA MENTAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2023
Last Update Date: 10/30/2023
Certification Date: 10/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

418 WILLARD AVE
GENOA NE
68640-3041
US

IV. Provider business mailing address

233 PAWNEE AVE
GENOA NE
68640-3032
US

V. Phone/Fax

Practice location:
  • Phone: 402-649-3509
  • Fax:
Mailing address:
  • Phone: 402-649-3509
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. CHAD SWANTEK
Title or Position: COO
Credential:
Phone: 402-649-3509