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General NPI Number Information
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NPI Number | 1598930117
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Entity Type | Organization
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Legal Business Name | PONCA TRIBE OF NEBRASKA
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Dates
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Enumeration Date | 04/24/2008
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Last Update Date | 04/24/2008
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Provider Practice Location Address
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Address Line | 1701 E ST
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City | LINCOLN
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State | NE
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Zip | 68508-3429
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Country | US
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Telephone | 402-438-9222
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Fax | 402-438-9226
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Provider Business Mailing Address
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Address Line | 1701 E ST
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City | LINCOLN
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State | NE
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Zip | 68508-3429
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Country | US
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Telephone | 402-438-9222
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Fax | 402-438-9226
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Authorized Official
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Title or Position | SUBSTANCE ABUSE COUNSELOR
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Name | MISS KELLI MICHIE OUCHI
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Credential | MA, PLHMP, PLADC
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Telephone | 402-438-9222
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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 | 8484
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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 | P-672
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License Number State | NE
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