Healthcare Provider Details

I. General information

NPI: 1215337100
Provider Name (Legal Business Name): DEMERATH COUNSELING AND THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2014
Last Update Date: 08/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 MAPLE ST.
PLAINVIEW NE
68769
US

IV. Provider business mailing address

106 MAPLE ST.
PLAINVIEW NE
68769
US

V. Phone/Fax

Practice location:
  • Phone: 402-302-4444
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number10334
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3843
License Number StateNE

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier100262266-00
Identifier TypeMEDICAID
Identifier StateNE
Identifier Issuer

VIII. Authorized Official

Name: JESSICA DEMERATH
Title or Position: THERAPIST
Credential: LMHP, LPC, RPT
Phone: 402-302-4444