=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750893988
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REBECCA MOLDEN COUNSELING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/27/2017
-----------------------------------------------------
Last Update Date | 03/17/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 811 N WASHINGTON ST
-----------------------------------------------------
City | LEXINGTON
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68850-1930
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 308-325-7234
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 305 CHEROKEE RD
-----------------------------------------------------
City | LEXINGTON
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68850-2750
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/THERAPIST
-----------------------------------------------------
Name | REBECCA MOLDEN
-----------------------------------------------------
Credential | LIMHP, CMSW
-----------------------------------------------------
Telephone | 308-325-7234
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 1679
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 1655
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------