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General NPI Number Information
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NPI Number | 1558784264
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Entity Type | Organization
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Legal Business Name | EXPRESSIVE ARTS NEBRASKA, LLC
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Dates
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Enumeration Date | 01/31/2014
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Last Update Date | 01/31/2014
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Provider Practice Location Address
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Address Line | 105 1/2 W D ST
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City | NORTH PLATTE
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State | NE
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Zip | 69101-5342
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Country | US
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Telephone | 308-529-0907
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Fax |
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Provider Business Mailing Address
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Address Line | 1917 AVENUE I
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City | GOTHENBURG
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State | NE
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Zip | 69138-1539
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Country | US
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Telephone | 308-529-0907
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Fax |
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Authorized Official
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Title or Position | OWNER/COUNSELOR
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Name | REBECCA HORN
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Credential | MS
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Telephone | 308-529-0907
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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 | 640
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License Number State | NE
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