=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790733095
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STELLA COUNSELING SERVICE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/05/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4727 N 26TH ST SUITE C
-----------------------------------------------------
City | LINCOLN
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68521-4706
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-465-4263
-----------------------------------------------------
Fax | 402-477-4328
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4727 N 26TH ST SUITE C
-----------------------------------------------------
City | LINCOLN
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68521-4706
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-465-4263
-----------------------------------------------------
Fax | 402-477-4328
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MENTAL HEALTH COUNSELOR
-----------------------------------------------------
Name | MS. STELLA A OFFORDIRINWA
-----------------------------------------------------
Credential | M.A. PLMHP
-----------------------------------------------------
Telephone | 402-304-4263
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 7518
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------