Healthcare Provider Details

I. General information

NPI: 1790029734
Provider Name (Legal Business Name): KLOCH COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2012
Last Update Date: 02/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 W 8TH ST SUITE A
LEXINGTON NE
68850-1971
US

IV. Provider business mailing address

101 W 8TH ST SUITE A
LEXINGTON NE
68850-1971
US

V. Phone/Fax

Practice location:
  • Phone: 308-324-7017
  • Fax: 866-578-3559
Mailing address:
  • Phone: 308-324-7017
  • Fax: 866-578-3559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number955
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number986
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number986
License Number StateNE

VIII. Authorized Official

Name: MRS. SUSAN M KLOCH
Title or Position: OWNER
Credential: LICSW, LADC
Phone: 308-324-7017