MEDICARE: SHIRLEY MARIE KRIESCH LMHP, LADC, CPC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	P-753	NE
2	101YM0800X	Mental Health Counselor	8779	NE
3	3747P1801X	Personal Care Attendant		NE

General Provider Information

NPI Number	:	1164709465
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHIRLEY MARIE KRIESCH LMHP, LADC, CPC

Provider Business Mailing Address
First Line	:	2304 N EASTWOOD ST LOT 15
Second Line	:
City	:	NORFOLK
State	:	NE
Zip	:	68701-1907
Country	:	US
Telephone Number	:	402-649-7401
Fax Number	:

Provider Business Practice Location Address
First Line	:	2304 N EASTWOOD ST LOT 15
Second Line	:
City	:	NORFOLK
State	:	NE
Zip	:	68701-1907
Country	:	US
Telephone Number	:	402-649-7401
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/15/2011
Last Update Date	:	03/05/2025

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