Basic Information
| Provider Information | |||||||||
| NPI: | 1679761381 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DENISE NEBEKER COUNSELING, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2205 S. 10TH STREET, STE 328 | ||||||||
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| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 68108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4025044102 | ||||||||
| FaxNumber: | 4025054188 | ||||||||
| Practice Location | |||||||||
| Address1: | 2205 S. 10TH STREET, STE 328 | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 68108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4025044102 | ||||||||
| FaxNumber: | 4025054188 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/09/2007 | ||||||||
| LastUpdateDate: | 10/09/2007 | ||||||||
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| AuthorizedOfficialLastName: | NEBEKER | ||||||||
| AuthorizedOfficialFirstName: | DENISE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 4025044102 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MA, LMHP, LPC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 2472 | NE | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 10025539000 | 05 | NE | MEDICAID |