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General NPI Number Information
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NPI Number | 1366840738
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Entity Type | Organization
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Legal Business Name | BROOKSTONE COUNSELING AND WELLNESS
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Dates
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Enumeration Date | 12/16/2014
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Last Update Date | 12/16/2014
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Provider Practice Location Address
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Address Line | 1013 NORTH 13 STREET SUITE 4
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City | NORFOLK
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State | NE
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Zip | 68701-2592
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Country | US
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Telephone | 402-369-6052
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Fax |
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Provider Business Mailing Address
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Address Line | 1013 N. 13TH STREET SUITE 4
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City | NORFOLK
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State | NE
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Zip | 68701-2592
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Country | US
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Telephone | 402-369-6052
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Fax |
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Authorized Official
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Title or Position | COUNSELOR
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Name | DR. BRANISLAVA KNEZEVIC
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Credential | LMHP
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Telephone | 402-404-0175
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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 | 4115
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License Number State | NE
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