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General NPI Number Information
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NPI Number | 1164650750
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Entity Type | Organization
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Legal Business Name | FOUR ROADS COUNSELING
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Dates
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Enumeration Date | 06/23/2009
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Last Update Date | 06/23/2009
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Provider Practice Location Address
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Address Line | 513 N GRANT ST SUIT 3 A
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City | LEXINGTON
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State | NE
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Zip | 68850-1946
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Country | US
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Telephone | 308-324-0222
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Fax | 308-324-0225
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Provider Business Mailing Address
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Address Line | 513 N GRANT ST SUIT 3 A
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City | LEXINGTON
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State | NE
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Zip | 68850-1946
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Country | US
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Telephone | 308-324-0222
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Fax | 308-324-0225
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Authorized Official
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Title or Position | OWNER
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Name | FERNANDO BARRANCO
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Credential | LADC
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Telephone | 308-324-0222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 454
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License Number State | NE
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