Provider Demographics
NPI:1386056661
Name:DESTINATION HOPE COUNSELING, LLC
Entity type:Organization
Organization Name:DESTINATION HOPE COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JANETTE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BENTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LIMHP, LMHP, LADC
Authorized Official - Phone:402-651-0684
Mailing Address - Street 1:511 N D ST
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68025-5051
Mailing Address - Country:US
Mailing Address - Phone:402-651-0684
Mailing Address - Fax:402-727-0779
Practice Address - Street 1:511 N D ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-5051
Practice Address - Country:US
Practice Address - Phone:402-651-0684
Practice Address - Fax:402-727-0779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-21
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3585251S00000X
NE1000251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1093039307OtherNPI