Healthcare Provider Details

I. General information

NPI: 1700635497
Provider Name (Legal Business Name): SHARED SOLUTIONS COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2024
Last Update Date: 06/06/2024
Certification Date: 06/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10206 CASPIAN DR
PAPILLION NE
68046-3234
US

IV. Provider business mailing address

10206 CASPIAN DR
PAPILLION NE
68046-3234
US

V. Phone/Fax

Practice location:
  • Phone: 402-250-7810
  • Fax:
Mailing address:
  • Phone: 402-250-7810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. LONGFELLOW MARQUEZ
Title or Position: EXECUTIVE DIRECTOR
Credential: LIMHP/LDAC
Phone: 402-250-7810