Healthcare Provider Details

I. General information

NPI: 1215402151
Provider Name (Legal Business Name): FULCRUM COUNSELING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2018
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11235 DAVENPORT ST STE 103H
OMAHA NE
68154-2690
US

IV. Provider business mailing address

11235 DAVENPORT ST STE 103H
OMAHA NE
68154-2690
US

V. Phone/Fax

Practice location:
  • Phone: 308-225-0500
  • Fax: 308-365-6848
Mailing address:
  • Phone: 308-225-0500
  • Fax: 308-365-6848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: SAMUEL WILLIAM CROUCH
Title or Position: OWNER
Credential:
Phone: 308-225-0500