Provider Demographics
NPI:1033480470
Name:WB COUNSELING LLC
Entity Type:Organization
Organization Name:WB COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:WALDA
Authorized Official - Middle Name:G
Authorized Official - Last Name:BOURGE
Authorized Official - Suffix:
Authorized Official - Credentials:LMHP
Authorized Official - Phone:308-530-4790
Mailing Address - Street 1:23718 E. FT. MCPHERSON RD.
Mailing Address - Street 2:
Mailing Address - City:BRADY
Mailing Address - State:NE
Mailing Address - Zip Code:69123
Mailing Address - Country:US
Mailing Address - Phone:308-530-4790
Mailing Address - Fax:
Practice Address - Street 1:319 E. B ST.
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101
Practice Address - Country:US
Practice Address - Phone:308-532-5565
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-17
Last Update Date:2012-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3284101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty