Healthcare Provider Details

I. General information

NPI: 1528427382
Provider Name (Legal Business Name): DANA DOUGHERTY CSS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2016
Last Update Date: 02/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 S 17TH ST
LINCOLN NE
68502-3713
US

IV. Provider business mailing address

2201 S 17TH ST
LINCOLN NE
68502-3713
US

V. Phone/Fax

Practice location:
  • Phone: 402-441-7940
  • Fax: 402-591-5075
Mailing address:
  • Phone: 402-441-7940
  • Fax: 402-591-5075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: