Healthcare Provider Details

I. General information

NPI: 1235915208
Provider Name (Legal Business Name): UNLEASHED COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2023
Last Update Date: 09/06/2023
Certification Date: 09/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1335 M ST
GERING NE
69341-2800
US

IV. Provider business mailing address

1335 M ST
GERING NE
69341-2800
US

V. Phone/Fax

Practice location:
  • Phone: 308-672-9952
  • Fax:
Mailing address:
  • Phone: 308-672-9952
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: APRIL HIEATT
Title or Position: OWNER/PLMHP
Credential: PLMHP
Phone: 308-672-9952