Healthcare Provider Details

I. General information

NPI: 1912060476
Provider Name (Legal Business Name): OGALLALA COUNSELING INC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 E 10TH ST
OGALLALA NE
69153-1442
US

IV. Provider business mailing address

103 E 10TH ST
OGALLALA NE
69153-1442
US

V. Phone/Fax

Practice location:
  • Phone: 308-284-6519
  • Fax: 308-284-6513
Mailing address:
  • Phone: 308-284-6519
  • Fax: 308-284-6513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNE

VIII. Authorized Official

Name: MRS. BEVERLY ANN FRATES MCMAHON
Title or Position: THERAPIST PRESIDENT
Credential: MS LIMHP LADC
Phone: 308-289-6519