Provider Demographics
NPI:1518175496
Name:THE MOTHER CHILD CONNECTION, LLC
Entity Type:Organization
Organization Name:THE MOTHER CHILD CONNECTION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:COFFEY
Authorized Official - Suffix:
Authorized Official - Credentials:LMHP
Authorized Official - Phone:402-850-6280
Mailing Address - Street 1:11907 ARBOR STREET
Mailing Address - Street 2:SUITE E
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144
Mailing Address - Country:US
Mailing Address - Phone:402-502-1010
Mailing Address - Fax:402-502-1078
Practice Address - Street 1:11907 ARBOR ST
Practice Address - Street 2:SUITE E
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-3002
Practice Address - Country:US
Practice Address - Phone:402-502-1010
Practice Address - Fax:402-502-1078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2925101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025491000Medicaid
NE10025491000Medicaid