=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225120413
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CENTRAL NEBRASKA LIFE SKILLS, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/28/2006
-----------------------------------------------------
Last Update Date | 05/21/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2315 W 39TH ST SUITE 113
-----------------------------------------------------
City | KEARNEY
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68845-8327
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 308-234-8403
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2292
-----------------------------------------------------
City | KEARNEY
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68848-2292
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 308-234-8403
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHAIRPERSON
-----------------------------------------------------
Name | MR. F. LEE ARLINGTON
-----------------------------------------------------
Credential | MHP, CPC
-----------------------------------------------------
Telephone | 308-234-8403
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 1839
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------