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General NPI Number Information
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NPI Number | 1134446669
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Entity Type | Organization
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Legal Business Name | CAROL COUNTRYMAN N., PC
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Dates
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Enumeration Date | 04/23/2010
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Last Update Date | 09/26/2024
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Provider Practice Location Address
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Address Line | 2231 N 57TH ST
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City | LINCOLN
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State | NE
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Zip | 68505-1110
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Country | US
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Telephone | 402-429-5365
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Fax |
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Provider Business Mailing Address
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Address Line | 2231 N 57TH ST
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City | LINCOLN
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State | NE
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Zip | 68505-1110
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Country | US
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Telephone | 402-429-5365
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CAROL COUNTRYMAN NUNNALLY
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Credential | LCSW, LIMHP
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Telephone | 402-429-5365
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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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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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