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1620 Wilshire Dr Ste 222 Bellevue NE 68005-6600 | |
| (402) 536-9568 | |
| (402) 905-4767 |
| Full Name | |
|---|---|
| Speciality | Counselor - Professional |
| Location | 1620 Wilshire Dr Ste 222, Bellevue, Nebraska |
| Authorized Official Name and Position | Maria Clark (LIMHP) |
| Authorized Official Contact | 4025369568 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
2613 Blackhawk Dr Bellevue NE 68123-3707 Ph: (402) 536-9568 | 1620 Wilshire Dr Ste 222 Bellevue NE 68005-6600 Ph: (402) 536-9568 |
| NPI Number | 1568949923 |
|---|---|
| Provider Enumeration Date | 07/27/2018 |
| Last Update Date | 07/27/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568949923 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | 1579 (Nebraska) | Secondary |
| 101YP2500X | Counselor - Professional | 1579 (Nebraska) | Primary |
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