Provider Demographics
NPI:1164808994
Name:GUARDIAN COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:GUARDIAN COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TOMEKA
Authorized Official - Middle Name:C
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MBRS
Authorized Official - Phone:402-885-7672
Mailing Address - Street 1:6606 S 168TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68135-5420
Mailing Address - Country:US
Mailing Address - Phone:402-618-2660
Mailing Address - Fax:402-884-7177
Practice Address - Street 1:6606 S 168TH ST STE 200
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68135-5420
Practice Address - Country:US
Practice Address - Phone:402-618-2660
Practice Address - Fax:402-884-7177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-04
Last Update Date:2017-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1831101YM0800X
NE10597251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty