Healthcare Provider Details

I. General information

NPI: 1851457899
Provider Name (Legal Business Name): SAMARITAN COUNSELING CENTER CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 12/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8650 PIONEERS BLVD
LINCOLN NE
68520
US

IV. Provider business mailing address

8650 PIONEERS BLVD
LINCOLN NE
68520
US

V. Phone/Fax

Practice location:
  • Phone: 402-483-5117
  • Fax: 402-483-5154
Mailing address:
  • Phone: 402-483-5117
  • Fax: 402-483-5154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: RICHARD W. VAUTRAVERS
Title or Position: BOARD TREASURER
Credential:
Phone: 402-483-5117