Provider Demographics
NPI:1639581150
Name:CENTER CREEK COUNSELING
Entity Type:Organization
Organization Name:CENTER CREEK COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:CHASTITY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:INGRAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-470-1338
Mailing Address - Street 1:775 31 RD
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:NE
Mailing Address - Zip Code:68939-5158
Mailing Address - Country:US
Mailing Address - Phone:308-470-1338
Mailing Address - Fax:308-425-3167
Practice Address - Street 1:775 31 RD
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:NE
Practice Address - Zip Code:68939-5158
Practice Address - Country:US
Practice Address - Phone:308-470-1338
Practice Address - Fax:308-425-3167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-02
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE13421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025916400Medicaid
NA1760OtherMEDICARE PTAN
NE10025916700Medicaid
KS200433160FMedicaid
KS200433160BMedicaid