MEDICARE: SAMARITAN COUNSELING CENTER CORPORATION

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	103TC0700X	Clinical Psychologist
2	1041C0700X	Clinical Social Worker
3	101YP2500X	Professional Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	294412	OTHER		VALUE OPTIONS

General Provider Information

NPI Number	:	1851457899
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAMARITAN COUNSELING CENTER CORPORATION

Provider Business Mailing Address
First Line	:	8650 PIONEERS BLVD
Second Line	:
City	:	LINCOLN
State	:	NE
Zip	:	68520
Country	:	US
Telephone Number	:	402-483-5117
Fax Number	:	402-483-5154

Provider Business Practice Location Address
First Line	:	8650 PIONEERS BLVD
Second Line	:
City	:	LINCOLN
State	:	NE
Zip	:	68520
Country	:	US
Telephone Number	:	402-483-5117
Fax Number	:	402-483-5154

Authorized Official
Title or Position	:	BOARD TREASURER
Name	:	RICHARD W. VAUTRAVERS
Credential	:
Telephone Number	:	402-483-5117

Provider Enumeration Date	:	12/27/2006
Last Update Date	:	12/02/2009

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