Healthcare Provider Details

I. General information

NPI: 1013197094
Provider Name (Legal Business Name): OPTIMAL LIVING COUNSELING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2007
Last Update Date: 11/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

906 N ST
GERING NE
69341-3335
US

IV. Provider business mailing address

906 N ST
GERING NE
69341-3335
US

V. Phone/Fax

Practice location:
  • Phone: 308-436-4300
  • Fax:
Mailing address:
  • Phone: 308-436-4300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number8214
License Number StateNE

VIII. Authorized Official

Name: MRS. LISA M. BALL
Title or Position: OWNER/OPERATOR
Credential: MA, PLMHP
Phone: 308-436-4300