Provider Demographics
NPI:1285827899
Name:PRISM COUNSELING SERVICE LLC
Entity Type:Organization
Organization Name:PRISM COUNSELING SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:KUEHL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:402-964-2883
Mailing Address - Street 1:7701 PACIFIC ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-5480
Mailing Address - Country:US
Mailing Address - Phone:402-964-2883
Mailing Address - Fax:
Practice Address - Street 1:7701 PACIFIC ST
Practice Address - Street 2:SUITE 105
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-5480
Practice Address - Country:US
Practice Address - Phone:402-964-2883
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-27
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE277107Medicare PIN
NEE99944Medicare UPIN