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General NPI Number Information
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NPI Number | 1477326973
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Entity Type | Organization
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Legal Business Name | WYONE MENTAL HEALTH, LLC
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Dates
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Enumeration Date | 11/06/2023
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Last Update Date | 11/13/2023
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Provider Practice Location Address
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Address Line | 124 W 25TH ST STE B4
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City | KEARNEY
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State | NE
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Zip | 68847-4473
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Country | US
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Telephone | 308-627-9076
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Fax | 308-455-1000
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Provider Business Mailing Address
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Address Line | 124 W 25TH ST STE B4
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City | KEARNEY
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State | NE
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Zip | 68847-4473
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Country | US
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Telephone | 308-627-9076
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Fax |
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Authorized Official
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Title or Position | LICENSED INDEPENDENT MENTAL HEALTH
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Name | MR. JACOB R. STOTLER
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Credential | LIMHP
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Telephone | 307-677-1618
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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 |
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License Number State |
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