Healthcare Provider Details

I. General information

NPI: 1740621168
Provider Name (Legal Business Name): CHARLES MICHAEL KOHLER MSW, CSW-PIP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MIKE KOHLER MSW, CSW-PIP

II. Dates (important events)

Enumeration Date: 07/14/2013
Last Update Date: 12/04/2023
Certification Date: 12/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 E 12TH ST
NORTH PLATTE NE
69101-2365
US

IV. Provider business mailing address

7929 W CENTER RD
OMAHA NE
68124-3104
US

V. Phone/Fax

Practice location:
  • Phone: 308-532-0587
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3540
License Number StateSD
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2883
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: