| Carol Countryman N., Pc | |
|
2231 N 57th St Lincoln NE 68505-1110 | |
| (402) 429-5365 | |
| Not Available |
| Full Name | Carol Countryman N., Pc |
|---|---|
| Speciality | Social Worker |
| Location | 2231 N 57th St, Lincoln, Nebraska |
| Authorized Official Name and Position | Carol Countryman Nunnally (OWNER) |
| Authorized Official Contact | 4024295365 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Carol Countryman N., Pc 2231 N 57th St Lincoln NE 68505-1110 Ph: (402) 429-5365 | Carol Countryman N., Pc 2231 N 57th St Lincoln NE 68505-1110 Ph: (402) 429-5365 |
| NPI Number | 1134446669 |
|---|---|
| Provider Enumeration Date | 04/23/2010 |
| Last Update Date | 09/26/2024 |
| Certification Date | 09/26/2024 |
| Medicare PECOS PAC ID | 3274666128 |
|---|---|
| Medicare Enrollment ID | O20100729000692 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134446669 | NPI | - | NPPES |
| 10025851300 | Medicaid | NE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Secondary |
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Carol Countryman Nunnally |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1093876872 PECOS PAC ID: 6507895125 Enrollment ID: I20050915000505 |
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