Provider Demographics
NPI:1265269104
Name:LIVING WATER COUNSELING CENTER
Entity type:Organization
Organization Name:LIVING WATER COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:KADRA
Authorized Official - Middle Name:
Authorized Official - Last Name:OMEROVIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-421-1182
Mailing Address - Street 1:2820 O ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-1343
Mailing Address - Country:US
Mailing Address - Phone:402-413-0786
Mailing Address - Fax:
Practice Address - Street 1:2820 O ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-1343
Practice Address - Country:US
Practice Address - Phone:402-413-0786
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty