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General NPI Number Information
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NPI Number | 1811203722
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Entity Type | Organization
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Legal Business Name | OLD MILL COUNSELING, LLC
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Dates
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Enumeration Date | 08/30/2010
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Last Update Date | 08/30/2010
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Provider Practice Location Address
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Address Line | 712 W KOENIG ST
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City | GRAND ISLAND
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State | NE
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Zip | 68801-6556
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Country | US
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Telephone | 308-382-4495
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Fax | 308-385-0407
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Provider Business Mailing Address
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Address Line | 712 W KOENIG ST
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City | GRAND ISLAND
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State | NE
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Zip | 68801-6556
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Country | US
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Telephone | 308-382-4495
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Fax | 308-385-0407
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Authorized Official
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Title or Position | MANAGER
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Name | MR. DAVID REHOV SKY
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Credential | M.S.MANAGER
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Telephone | 308-382-4495
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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 | 1330
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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 | 9115
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License Number State | NE
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 1001
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License Number State | NE
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