Provider Demographics
NPI:1558784264
Name:EXPRESSIVE ARTS NEBRASKA, LLC
Entity Type:Organization
Organization Name:EXPRESSIVE ARTS NEBRASKA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:HORN
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:308-529-0907
Mailing Address - Street 1:1917 AVENUE I
Mailing Address - Street 2:
Mailing Address - City:GOTHENBURG
Mailing Address - State:NE
Mailing Address - Zip Code:69138-1539
Mailing Address - Country:US
Mailing Address - Phone:308-529-0907
Mailing Address - Fax:
Practice Address - Street 1:105 1/2 W D ST
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-5342
Practice Address - Country:US
Practice Address - Phone:308-529-0907
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-31
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE640101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty