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General NPI Number Information
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NPI Number | 1043012602
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Entity Type | Organization
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Legal Business Name | GREEN WAVE COUNSELING AND WELLNESS
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Dates
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Enumeration Date | 03/25/2025
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Last Update Date | 03/25/2025
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Provider Practice Location Address
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Address Line | 524 VERONA AVE
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City | RAVENNA
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State | NE
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Zip | 68869-1242
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Country | US
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Telephone | 308-440-3119
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Fax |
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Provider Business Mailing Address
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Address Line | 524 VERONA AVE
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City | RAVENNA
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State | NE
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Zip | 68869-1242
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Country | US
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Telephone | 308-440-3119
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | HOLLY SCHMIDT
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Credential |
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Telephone | 308-440-3119
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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