MEDICARE: PROFESSIONAL MENTAL HEALTH SERVICES, L.L.C.

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	1541	NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356517858
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROFESSIONAL MENTAL HEALTH SERVICES, L.L.C.

Provider Business Mailing Address
First Line	:	5 ROBIN LN
Second Line	:
City	:	COLUMBUS
State	:	NE
Zip	:	68601-6200
Country	:	US
Telephone Number	:	402-562-7099
Fax Number	:

Provider Business Practice Location Address
First Line	:	3314 26TH ST
Second Line	:	SUITE D
City	:	COLUMBUS
State	:	NE
Zip	:	68601-2304
Country	:	US
Telephone Number	:	402-562-7099
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MS. JOLAINE LYNN EDWARDS
Credential	:	LCSW
Telephone Number	:	402-562-7099

Provider Enumeration Date	:	05/05/2008
Last Update Date	:	05/05/2008

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