Provider Demographics
NPI:1699327098
Name:DEBORAH GRACE THIMSEN-VILLA DBA VERIGRATIA COUNSELING
Entity type:Organization
Organization Name:DEBORAH GRACE THIMSEN-VILLA DBA VERIGRATIA COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:GRACE
Authorized Official - Last Name:THIMSEN-VILLA
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LIMHP
Authorized Official - Phone:402-984-4508
Mailing Address - Street 1:1917 W FAIDLEY AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-4642
Mailing Address - Country:US
Mailing Address - Phone:402-984-4508
Mailing Address - Fax:
Practice Address - Street 1:1917 W FAIDLEY AVE
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-4642
Practice Address - Country:US
Practice Address - Phone:308-398-0350
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-15
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1002680080Medicaid