Healthcare Provider Details

I. General information

NPI: 1720316391
Provider Name (Legal Business Name): THE WELL NE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2009
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 W PASEWALK AVE
NORFOLK NE
68701-5650
US

IV. Provider business mailing address

PO BOX 1392
NORFOLK NE
68702-1392
US

V. Phone/Fax

Practice location:
  • Phone: 402-371-0220
  • Fax:
Mailing address:
  • Phone: 402-379-3622
  • Fax: 402-644-4593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License NumberSATC036
License Number StateNE

VIII. Authorized Official

Name: DONIELLE LARSON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 402-371-0220