=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104986884
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MENTAL AND BEHAVIORAL HEALTH, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/11/2006
-----------------------------------------------------
Last Update Date | 03/28/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3314 26TH STREET STE A
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68601-2304
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-564-9888
-----------------------------------------------------
Fax | 402-564-9899
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3314 26TH STREET STE A
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68601-2304
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-564-9888
-----------------------------------------------------
Fax | 402-564-9899
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CO CLINICAL DIRECTOR;THEARPIST
-----------------------------------------------------
Name | ALICIA MICHELLE KUESTER
-----------------------------------------------------
Credential | LIMHP
-----------------------------------------------------
Telephone | 402-564-9888
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 2600
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 2501
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 7854
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | 622
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------