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General NPI Number Information
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NPI Number | 1093118218
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL CARE COUNSELING SERVICE
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Dates
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Enumeration Date | 10/01/2014
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Last Update Date | 10/01/2014
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Provider Practice Location Address
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Address Line | 205 S CEDAR ST
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City | GRAND ISLAND
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State | NE
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Zip | 68801-6582
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Country | US
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Telephone | 308-370-1667
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Fax | 402-298-2523
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Provider Business Mailing Address
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Address Line | 205 S CEDAR ST
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City | GRAND ISLAND
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State | NE
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Zip | 68801-6582
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Country | US
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Telephone | 308-370-1667
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Fax | 402-298-2523
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Authorized Official
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Title or Position | OUTPATIENT THERAPIST
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Name | MR. THOMAS BRIAN FLOREZ
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Credential | PLMHP/PLADC
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Telephone | 308-370-1667
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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 | 10016
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License Number State | NE
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | P-1145
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License Number State | NE
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