Provider Demographics
NPI:1104986884
Name:MENTAL AND BEHAVIORAL HEALTH, INC.
Entity type:Organization
Organization Name:MENTAL AND BEHAVIORAL HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO CLINICAL DIRECTOR;THEARPIST
Authorized Official - Prefix:
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:KUESTER
Authorized Official - Suffix:
Authorized Official - Credentials:LIMHP
Authorized Official - Phone:402-564-9888
Mailing Address - Street 1:3314 26TH STREET
Mailing Address - Street 2:STE A
Mailing Address - City:COLUMBUS
Mailing Address - State:NE
Mailing Address - Zip Code:68601-2304
Mailing Address - Country:US
Mailing Address - Phone:402-564-9888
Mailing Address - Fax:402-564-9899
Practice Address - Street 1:3314 26TH STREET
Practice Address - Street 2:STE A
Practice Address - City:COLUMBUS
Practice Address - State:NE
Practice Address - Zip Code:68601-2304
Practice Address - Country:US
Practice Address - Phone:402-564-9888
Practice Address - Fax:402-564-9899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2600101YM0800X
NE2501101YM0800X
NE7854101YM0800X
NE622103T00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE230777OtherMIDLANDS CHOICE
NE10025268300Medicaid
NE247195OtherMIDLANDS CHOICE
NE241063OtherMIDLANDS CHOICE
NE85313OtherBCBS
NE08318OtherBCBS
NE85316OtherBCBS
NE241063OtherMIDLANDS CHOICE
NE247195OtherMIDLANDS CHOICE