MEDICARE: VICKI HOLOUBECK, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	755	NE

General Provider Information

NPI Number	:	1144574609
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VICKI HOLOUBECK, INC

Provider Business Mailing Address
First Line	:	1406 FORT CROOK RD S
Second Line	:	SUITE 401
City	:	BELLEVUE
State	:	NE
Zip	:	68005-2992
Country	:	US
Telephone Number	:	402-880-9453
Fax Number	:	402-292-0144

Provider Business Practice Location Address
First Line	:	1406 FORT CROOK RD S
Second Line	:	SUITE 401
City	:	BELLEVUE
State	:	NE
Zip	:	68005-2992
Country	:	US
Telephone Number	:	402-880-9453
Fax Number	:	402-292-0144

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	VICKI L HOLOUBECK
Credential	:	LIMHP
Telephone Number	:	402-880-9453

Provider Enumeration Date	:	11/06/2012
Last Update Date	:	06/23/2016

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