Provider Demographics
NPI:1003347378
Name:REBEKAH SHUNKWILER COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:REBEKAH SHUNKWILER COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DUAL DIAGNOSIS THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:REBEKAH
Authorized Official - Middle Name:
Authorized Official - Last Name:SHUNKWILER
Authorized Official - Suffix:
Authorized Official - Credentials:LIMHP, PLADC
Authorized Official - Phone:308-385-8404
Mailing Address - Street 1:PO BOX 181
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:NE
Mailing Address - Zip Code:68864-0181
Mailing Address - Country:US
Mailing Address - Phone:308-385-8404
Mailing Address - Fax:
Practice Address - Street 1:1811 W 2ND ST
Practice Address - Street 2:SUITE 360
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-5413
Practice Address - Country:US
Practice Address - Phone:308-385-8404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-27
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEP-1093101YA0400X
NE1588101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1245643717OtherINDIVIDUAL NPI
NE3919012900Medicaid