=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730070160
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CYNTHIA KISSACK COUNSELING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/14/2025
-----------------------------------------------------
Last Update Date | 07/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1811 W 2ND ST STE 450
-----------------------------------------------------
City | GRAND ISLAND
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68803-5473
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 308-379-8619
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2517 S AUGUST ST
-----------------------------------------------------
City | GRAND ISLAND
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68801-7531
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 308-379-8619
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LIMHP
-----------------------------------------------------
Name | CYNTHIA L KISSACK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 308-379-8619
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------