Healthcare Provider Details

I. General information

NPI: 1215832548
Provider Name (Legal Business Name): MAPLE MENTAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4503 CENTRAL AVE
KEARNEY NE
68847-2540
US

IV. Provider business mailing address

4503 CENTRAL AVE
KEARNEY NE
68847-2540
US

V. Phone/Fax

Practice location:
  • Phone: 308-627-8149
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MARY RACKLEY
Title or Position: PRESIDENT
Credential: PLMHP
Phone: 308-627-8149