Provider Demographics
NPI:1861043796
Name:INFINITE AVENUES COUNSELING
Entity Type:Organization
Organization Name:INFINITE AVENUES COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:SEGOVIANO
Authorized Official - Suffix:
Authorized Official - Credentials:PLADC
Authorized Official - Phone:402-301-6813
Mailing Address - Street 1:4539 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68117-2622
Mailing Address - Country:US
Mailing Address - Phone:402-301-6813
Mailing Address - Fax:
Practice Address - Street 1:7117 FARNAM ST STE 17
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68132-3319
Practice Address - Country:US
Practice Address - Phone:531-301-7817
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-23
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility