Healthcare Provider Details

I. General information

NPI: 1770127904
Provider Name (Legal Business Name): ROZ SHELDON COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2019
Last Update Date: 08/27/2020
Certification Date: 08/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3710 CENTRAL AVE STE 9
KEARNEY NE
68847-8126
US

IV. Provider business mailing address

3710 CENTRAL AVE STE 9
KEARNEY NE
68847-8126
US

V. Phone/Fax

Practice location:
  • Phone: 308-251-2222
  • Fax:
Mailing address:
  • Phone: 308-251-2222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINE MIALI
Title or Position: BILLER
Credential:
Phone: 402-504-4680