Provider Demographics
NPI:1649625658
Name:PEACE, HOPE AND LIFE COUNSELING, INC
Entity type:Organization
Organization Name:PEACE, HOPE AND LIFE COUNSELING, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:KAYE
Authorized Official - Middle Name:MINDT
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LIMHP
Authorized Official - Phone:308-382-8085
Mailing Address - Street 1:1811 W 2ND ST
Mailing Address - Street 2:STE 450
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-5473
Mailing Address - Country:US
Mailing Address - Phone:308-382-8085
Mailing Address - Fax:308-339-0962
Practice Address - Street 1:1811 W 2ND ST
Practice Address - Street 2:STE 450
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-5473
Practice Address - Country:US
Practice Address - Phone:308-382-8085
Practice Address - Fax:308-339-0962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-27
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE10782, P-1372101YM0800X
NE320, 787, 511101YM0800X
NE1249, 4370, 2124101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty