Healthcare Provider Details

I. General information

NPI: 1073520508
Provider Name (Legal Business Name): CORA S. BERRY MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 W 13TH ST
MCCOOK NE
69001-2927
US

IV. Provider business mailing address

812 W 13TH ST
MCCOOK NE
69001-2927
US

V. Phone/Fax

Practice location:
  • Phone: 308-345-1429
  • Fax: 308-345-6513
Mailing address:
  • Phone: 308-345-1429
  • Fax: 308-345-6513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number011
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number393
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number284
License Number StateNE
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number103
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: