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General NPI Number Information
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NPI Number | 1386056661
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Entity Type | Organization
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Legal Business Name | DESTINATION HOPE COUNSELING, LLC
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Dates
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Enumeration Date | 05/21/2014
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Last Update Date | 05/21/2014
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Provider Practice Location Address
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Address Line | 511 N D ST
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City | FREMONT
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State | NE
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Zip | 68025-5051
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Country | US
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Telephone | 402-651-0684
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Fax | 402-727-0779
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Provider Business Mailing Address
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Address Line | 511 N D ST
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City | FREMONT
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State | NE
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Zip | 68025-5051
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Country | US
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Telephone | 402-651-0684
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Fax | 402-727-0779
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Authorized Official
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Title or Position | OWNER THERAPIST
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Name | JANETTE LYNN BENTLEY
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Credential | LIMHP, LMHP, LADC
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Telephone | 402-651-0684
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 1000
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License Number State | NE
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 3585
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License Number State | NE
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