Provider Demographics
NPI:1366840738
Name:BROOKSTONE COUNSELING AND WELLNESS
Entity Type:Organization
Organization Name:BROOKSTONE COUNSELING AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANISLAVA
Authorized Official - Middle Name:
Authorized Official - Last Name:KNEZEVIC
Authorized Official - Suffix:
Authorized Official - Credentials:LMHP
Authorized Official - Phone:402-404-0175
Mailing Address - Street 1:1013 N. 13TH STREET
Mailing Address - Street 2:SUITE 4
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-2592
Mailing Address - Country:US
Mailing Address - Phone:402-369-6052
Mailing Address - Fax:
Practice Address - Street 1:1013 NORTH 13 STREET
Practice Address - Street 2:SUITE 4
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-2592
Practice Address - Country:US
Practice Address - Phone:402-369-6052
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-16
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE4115101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026415300Medicaid