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General NPI Number Information
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NPI Number | 1154693596
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Entity Type | Organization
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Legal Business Name | MICHELE MISSEL COUNSELING
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Dates
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Enumeration Date | 02/01/2012
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Last Update Date | 02/01/2012
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Provider Practice Location Address
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Address Line | 437 JEFFERSON RD
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City | FREMONT
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State | NE
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Zip | 68025-6049
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Country | US
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Telephone | 402-719-1778
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Fax |
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Provider Business Mailing Address
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Address Line | 427 N BIRCHWOOD DR
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City | FREMONT
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State | NE
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Zip | 68025-5435
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Country | US
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Telephone | 402-721-0591
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Fax |
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Authorized Official
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Title or Position | CLINICAL SOCIAL WORKER
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Name | MICHELE M MISSEL
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Credential | LIMHP, LCSW
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Telephone | 402-719-1778
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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 | 891
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License Number State | NE
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