Provider Demographics
NPI:1467639583
Name:ANN BROST MA COUNSELING AGENCY
Entity Type:Organization
Organization Name:ANN BROST MA COUNSELING AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER LMHP THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BROST
Authorized Official - Suffix:
Authorized Official - Credentials:LMHP
Authorized Official - Phone:308-432-6779
Mailing Address - Street 1:301 WEST 2ND ST
Mailing Address - Street 2:
Mailing Address - City:CHADRON
Mailing Address - State:NE
Mailing Address - Zip Code:69337
Mailing Address - Country:US
Mailing Address - Phone:308-432-6779
Mailing Address - Fax:308-432-6874
Practice Address - Street 1:301 WEST 2ND ST
Practice Address - Street 2:
Practice Address - City:CHADRON
Practice Address - State:NE
Practice Address - Zip Code:69337
Practice Address - Country:US
Practice Address - Phone:308-432-6779
Practice Address - Fax:308-432-6874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-31
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2653101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========26Medicaid