Healthcare Provider Details

I. General information

NPI: 1134446669
Provider Name (Legal Business Name): CAROL COUNTRYMAN N., PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2010
Last Update Date: 09/26/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2231 N 57TH ST
LINCOLN NE
68505-1110
US

IV. Provider business mailing address

2231 N 57TH ST
LINCOLN NE
68505-1110
US

V. Phone/Fax

Practice location:
  • Phone: 402-429-5365
  • Fax:
Mailing address:
  • Phone: 402-429-5365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: CAROL COUNTRYMAN NUNNALLY
Title or Position: OWNER
Credential: LCSW, LIMHP
Phone: 402-429-5365