=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417826991
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OUT OF THE ASHES MENTAL HEALTH
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/03/2025
-----------------------------------------------------
Last Update Date | 11/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1408 FORT CROOK RD S
-----------------------------------------------------
City | BELLEVUE
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68005-3061
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 712-209-7155
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 57057 230TH ST
-----------------------------------------------------
City | GLENWOOD
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 51534-6199
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PLMPH
-----------------------------------------------------
Name | JODI STEPHEN
-----------------------------------------------------
Credential | PLMHP
-----------------------------------------------------
Telephone | 712-209-7155
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------