Healthcare Provider Details

I. General information

NPI: 1093876872
Provider Name (Legal Business Name): CAROL COUNTRYMAN NUNNALLY LCSW LIMHP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CAROL COUNTRYMAN LCSW, LIMHP

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 10/25/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4444 S 86TH T STE 102
LINCOLN NE
68526-9253
US

IV. Provider business mailing address

PO BOX 57475
LINCOLN NE
68505
US

V. Phone/Fax

Practice location:
  • Phone: 402-476-7557
  • Fax: 402-476-9912
Mailing address:
  • Phone: 402-429-5365
  • Fax: 402-476-9912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1136
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number67
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: