MEDICARE: NOLAN COUNSELING, PC

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	251S00000X	Community/Behavioral Health Agency	1438	NE
2	251S00000X	Community/Behavioral Health Agency	P-938	NE
3	251S00000X	Community/Behavioral Health Agency	4044	NE

General Provider Information

NPI Number	:	1831465202
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOLAN COUNSELING, PC

Provider Business Mailing Address
First Line	:	3221 RAMADA RD
Second Line	:
City	:	GRAND ISLAND
State	:	NE
Zip	:	68801-8800
Country	:	US
Telephone Number	:	308-440-5626
Fax Number	:

Provider Business Practice Location Address
First Line	:	3221 RAMADA RD
Second Line	:
City	:	GRAND ISLAND
State	:	NE
Zip	:	68801-8800
Country	:	US
Telephone Number	:	308-440-5626
Fax Number	:

Authorized Official
Title or Position	:	THERAPIST/OWNER
Name	:	KORENA NOLAN
Credential	:	L.C.S.W., L.M.H.P.
Telephone Number	:	308-440-5626

Provider Enumeration Date	:	03/29/2012
Last Update Date	:	03/29/2012

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