=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639442668
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADURAY COUNSELING SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/22/2012
-----------------------------------------------------
Last Update Date | 02/22/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1036 LAKE ST
-----------------------------------------------------
City | LINCOLN
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68502-3530
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-304-4622
-----------------------------------------------------
Fax | 402-328-0346
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1036 LAKE ST
-----------------------------------------------------
City | LINCOLN
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68502-3530
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-304-4622
-----------------------------------------------------
Fax | 402-328-0346
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | CATHERINE MOSS
-----------------------------------------------------
Credential | LIMHP
-----------------------------------------------------
Telephone | 402-304-4622
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | 484
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------