Healthcare Provider Details

I. General information

NPI: 1336910959
Provider Name (Legal Business Name): NEBRASKA COUNSELING ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2024
Last Update Date: 02/21/2024
Certification Date: 02/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

916 AVENUE F
GOTHENBURG NE
69138-2060
US

IV. Provider business mailing address

202 5TH ST
GOTHENBURG NE
69138-2213
US

V. Phone/Fax

Practice location:
  • Phone: 308-440-8054
  • Fax: 308-234-6604
Mailing address:
  • Phone: 308-440-8054
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: BETTY L JOHNSON
Title or Position: DIRECTOS
Credential: MA, LIMHP, LADC
Phone: 308-440-8054