Provider Demographics
NPI:1114107711
Name:ALLIANCE COUNSELING CENTER
Entity Type:Organization
Organization Name:ALLIANCE COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:NELSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LMHP, CPC, NCC
Authorized Official - Phone:402-965-4004
Mailing Address - Street 1:11920 BURT ST
Mailing Address - Street 2:SUITE # 190
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-1598
Mailing Address - Country:US
Mailing Address - Phone:402-965-4004
Mailing Address - Fax:
Practice Address - Street 1:11920 BURT ST
Practice Address - Street 2:SUITE # 190
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-1598
Practice Address - Country:US
Practice Address - Phone:402-965-4004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-12
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE633101YM0800X
NE1546101YM0800X
NE1461101YM0800X
NE1695101YM0800X
NE283103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE100253006-00Medicaid