Provider Demographics
NPI:1851457899
Name:SAMARITAN COUNSELING CENTER CORPORATION
Entity Type:Organization
Organization Name:SAMARITAN COUNSELING CENTER CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:W
Authorized Official - Last Name:VAUTRAVERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-483-5117
Mailing Address - Street 1:8650 PIONEERS BLVD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68520
Mailing Address - Country:US
Mailing Address - Phone:402-483-5117
Mailing Address - Fax:402-483-5154
Practice Address - Street 1:8650 PIONEERS BLVD
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68520
Practice Address - Country:US
Practice Address - Phone:402-483-5117
Practice Address - Fax:402-483-5154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
294412OtherVALUE OPTIONS
294412OtherVALUE OPTIONS
=========OtherBCBS
NE=========26Medicaid