=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073967014
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADVANCE COUNSELING SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/15/2016
-----------------------------------------------------
Last Update Date | 04/15/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 220 W 7TH ST SUITE 1
-----------------------------------------------------
City | WAYNE
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68787-1302
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-833-5246
-----------------------------------------------------
Fax | 402-833-5283
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 220 W 7TH ST SUITE 1
-----------------------------------------------------
City | WAYNE
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68787-1302
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-833-5246
-----------------------------------------------------
Fax | 402-833-5283
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER, MENTAL HEALTH THERAPIST
-----------------------------------------------------
Name | JANICE LYNN CHINN
-----------------------------------------------------
Credential | LIMHP, CPC
-----------------------------------------------------
Telephone | 402-833-5246
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | 1548
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------