Provider Demographics
NPI:1477026177
Name:GRANBERG, KAREN M (LMHP, CPC)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:M
Last Name:GRANBERG
Suffix:
Gender:F
Credentials:LMHP, CPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 14
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NE
Mailing Address - Zip Code:68787-0014
Mailing Address - Country:US
Mailing Address - Phone:402-375-1506
Mailing Address - Fax:
Practice Address - Street 1:421 N PEARL ST RM 206
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NE
Practice Address - Zip Code:68787-1904
Practice Address - Country:US
Practice Address - Phone:402-369-4752
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-04
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1004101Y00000X, 101YM0800X
NE851101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional