Provider Demographics
NPI:1346759099
Name:RED COUCH COUNSELING LLC
Entity Type:Organization
Organization Name:RED COUCH COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING AND BILLING
Authorized Official - Prefix:MRS
Authorized Official - First Name:KADRA
Authorized Official - Middle Name:
Authorized Official - Last Name:OMEROVIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-421-1182
Mailing Address - Street 1:914 P STREET
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:NE
Mailing Address - Zip Code:68361-9999
Mailing Address - Country:US
Mailing Address - Phone:402-710-0564
Mailing Address - Fax:
Practice Address - Street 1:914 P STREET
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:NE
Practice Address - Zip Code:68361-9999
Practice Address - Country:US
Practice Address - Phone:402-710-0564
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1277101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE54985944801Medicaid