Healthcare Provider Details

I. General information

NPI: 1003967670
Provider Name (Legal Business Name): DAVID A. REHOVSKY MS,LMHP,PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

712 W KOENIG ST
GRAND ISLAND NE
68801-6556
US

IV. Provider business mailing address

712 W KOENIG ST
GRAND ISLAND NE
68801-6556
US

V. Phone/Fax

Practice location:
  • Phone: 308-382-4495
  • Fax:
Mailing address:
  • Phone: 308-382-4495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1001
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: