Provider Demographics
NPI:1174784821
Name:COUNSELING CONNECTIONS, LLC
Entity type:Organization
Organization Name:COUNSELING CONNECTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:TACKETT-NEWBURG
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LIMHP, CPC
Authorized Official - Phone:402-932-2296
Mailing Address - Street 1:11414 W CENTER RD
Mailing Address - Street 2:SUITE 124
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-4486
Mailing Address - Country:US
Mailing Address - Phone:402-932-2296
Mailing Address - Fax:402-933-9335
Practice Address - Street 1:11414 W CENTER RD
Practice Address - Street 2:SUITE 124
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-4486
Practice Address - Country:US
Practice Address - Phone:402-932-2296
Practice Address - Fax:402-933-9335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-24
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE293251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025043400Medicaid