Provider Demographics
NPI:1740332691
Name:CENTRAL COUNSELING ASSOCIATES
Entity type:Organization
Organization Name:CENTRAL COUNSELING ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHTHERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:DODSON MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:402-393-1647
Mailing Address - Street 1:4848 S 120TH ST
Mailing Address - Street 2:STE 410
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-2065
Mailing Address - Country:US
Mailing Address - Phone:402-393-1647
Mailing Address - Fax:402-333-0556
Practice Address - Street 1:4848 S 120TH ST
Practice Address - Street 2:STE 410
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-2065
Practice Address - Country:US
Practice Address - Phone:402-393-1647
Practice Address - Fax:402-333-0556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE618101YP2500X
NE262103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========26Medicaid
NE098382Medicare ID - Type Unspecified