MEDICARE: CASSI STARK LIMHP

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	1812	NE
2	101YM0800X	Mental Health Counselor	8324	NE
3	101YM0800X	Mental Health Counselor	082666	IA
4	101YM0800X	Mental Health Counselor	854	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	:	1912102310
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASSI STARK LIMHP

Provider Business Mailing Address
First Line	:	PO BOX 894
Second Line	:
City	:	PONCA
State	:	NE
Zip	:	68770-0894
Country	:	US
Telephone Number	:	308-631-9456
Fax Number	:	308-532-0389

Provider Business Practice Location Address
First Line	:	1000 W 29TH ST STE 230
Second Line	:
City	:	SOUTH SIOUX CITY
State	:	NE
Zip	:	68776-3852
Country	:	US
Telephone Number	:	402-913-0552
Fax Number	:

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

Provider Enumeration Date	:	06/18/2007
Last Update Date	:	10/01/2021

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Directions to “ CASSI STARK LIMHP” Practice Location

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