MEDICARE: GRANITE COUNSELING LLC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1992590160
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRANITE COUNSELING LLC

Provider Business Mailing Address
First Line	:	900 RIVERSIDE BLVD
Second Line	:
City	:	NORFOLK
State	:	NE
Zip	:	68701-2896
Country	:	US
Telephone Number	:	402-371-9606
Fax Number	:

Provider Business Practice Location Address
First Line	:	900 RIVERSIDE BLVD
Second Line	:
City	:	NORFOLK
State	:	NE
Zip	:	68701-2896
Country	:	US
Telephone Number	:	402-371-9606
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LAURA STOLTZ
Credential	:	LMHP
Telephone Number	:	402-709-7411

Provider Enumeration Date	:	04/10/2025
Last Update Date	:	04/10/2025

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