Provider Demographics
NPI:1992881270
Name:COUNSELING AFFILIATES OF NEBRASKA LLC
Entity type:Organization
Organization Name:COUNSELING AFFILIATES OF NEBRASKA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:LOU
Authorized Official - Last Name:PAINE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:402-488-4489
Mailing Address - Street 1:1550 S 70TH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-1576
Mailing Address - Country:US
Mailing Address - Phone:402-488-0077
Mailing Address - Fax:402-488-0017
Practice Address - Street 1:1550 S 70TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-1576
Practice Address - Country:US
Practice Address - Phone:402-488-0077
Practice Address - Fax:402-488-0017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-28
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE559103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE100254513000Medicaid