Healthcare Provider Details

I. General information

NPI: 1740332691
Provider Name (Legal Business Name): CENTRAL COUNSELING ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 10/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4848 S 120TH ST STE 410
OMAHA NE
68137-2065
US

IV. Provider business mailing address

4848 S 120TH ST STE 410
OMAHA NE
68137-2065
US

V. Phone/Fax

Practice location:
  • Phone: 402-393-1647
  • Fax: 402-333-0556
Mailing address:
  • Phone: 402-393-1647
  • Fax: 402-333-0556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number618
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number262
License Number StateNE

VIII. Authorized Official

Name: MS. JANE DODSON MARTIN
Title or Position: PSYCHTHERAPIST
Credential: MS
Phone: 402-393-1647