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General NPI Number Information
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NPI Number | 1902625650
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Entity Type | Organization
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Legal Business Name | MAIN STREET COUNSELING
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Dates
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Enumeration Date | 10/09/2024
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Last Update Date | 10/09/2024
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Provider Practice Location Address
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Address Line | 1735 E MILITARY AVE STE 4
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City | FREMONT
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State | NE
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Zip | 68025-5402
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Country | US
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Telephone | 402-275-1961
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 319
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City | CEDAR BLUFFS
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State | NE
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Zip | 68015-0319
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Country | US
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Telephone | 402-275-1961
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Fax |
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Authorized Official
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Title or Position | PROVIDER
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Name | HOLLY PORTER
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Credential | LADC
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Telephone | 402-275-1961
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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