Provider Demographics
NPI:1427427004
Name:MORIAH EICKHOFF COUNSELING, LLC
Entity type:Organization
Organization Name:MORIAH EICKHOFF COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MORIAH
Authorized Official - Middle Name:
Authorized Official - Last Name:EICKHOFF
Authorized Official - Suffix:
Authorized Official - Credentials:LIMHP, LADC
Authorized Official - Phone:308-221-6868
Mailing Address - Street 1:809 S SILBER AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-6176
Mailing Address - Country:US
Mailing Address - Phone:308-221-6868
Mailing Address - Fax:308-221-6868
Practice Address - Street 1:809 S SILBER AVE
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-6176
Practice Address - Country:US
Practice Address - Phone:308-221-6868
Practice Address - Fax:308-221-6868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-24
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1017251S00000X
NE816251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE600410047Medicaid