Healthcare Provider Details

I. General information

NPI: 1316446842
Provider Name (Legal Business Name): SEASON OF CHANGE COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2018
Last Update Date: 03/01/2023
Certification Date: 03/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13513 COTTNER ST
OMAHA NE
68137-1629
US

IV. Provider business mailing address

13513 COTTNER ST
OMAHA NE
68137-1629
US

V. Phone/Fax

Practice location:
  • Phone: 402-590-8766
  • Fax: 402-838-7248
Mailing address:
  • Phone: 402-590-8766
  • Fax: 402-838-7248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: COURTNEY MERTES
Title or Position: OWNER
Credential: MS, LIMHP LADC LPC
Phone: 402-590-8766