Healthcare Provider Details

I. General information

NPI: 1912272873
Provider Name (Legal Business Name): WHOLENESS HEALING CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2012
Last Update Date: 08/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2608 OLD FAIR RD
GRAND ISLAND NE
68803-5271
US

IV. Provider business mailing address

3811 29TH AVE SUITE 5
KEARNEY NE
68845-1280
US

V. Phone/Fax

Practice location:
  • Phone: 308-382-5297
  • Fax: 308-382-5315
Mailing address:
  • Phone: 308-455-1560
  • Fax: 308-455-1450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number9086
License Number StateNE

VIII. Authorized Official

Name: MS. MICHELLE L CHOPLIN
Title or Position: BILLING SPECIALIST
Credential:
Phone: 308-382-5297