Provider Demographics
NPI:1033969019
Name:PROCHASKA, GENOVEVA
Entity Type:Individual
Prefix:
First Name:GENOVEVA
Middle Name:
Last Name:PROCHASKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5600 P ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68505-2331
Mailing Address - Country:US
Mailing Address - Phone:402-261-6667
Mailing Address - Fax:402-261-6526
Practice Address - Street 1:5600 P ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68505-2331
Practice Address - Country:US
Practice Address - Phone:402-261-6667
Practice Address - Fax:402-261-6526
Is Sole Proprietor?:No
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE13731101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)