Healthcare Provider Details

I. General information

NPI: 1497413926
Provider Name (Legal Business Name): FOUR CORNERS HEALTH DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2021
Last Update Date: 12/28/2023
Certification Date: 12/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 N LINCOLN AVE
YORK NE
68467-1027
US

IV. Provider business mailing address

2101 N LINCOLN AVE
YORK NE
68467-1027
US

V. Phone/Fax

Practice location:
  • Phone: 402-362-2621
  • Fax: 402-362-2687
Mailing address:
  • Phone: 402-362-2621
  • Fax: 402-362-2687

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 TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: LAURA MCDOUGALL
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 402-362-2621