Provider Demographics
NPI:1740655265
Name:CORA S. BERRY PC
Entity type:Organization
Organization Name:CORA S. BERRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CORA
Authorized Official - Middle Name:SIMMERMAN
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:LMHP LCPC, LPC, LADC
Authorized Official - Phone:308-345-1429
Mailing Address - Street 1:812 W 13TH ST
Mailing Address - Street 2:
Mailing Address - City:MC COOK
Mailing Address - State:NE
Mailing Address - Zip Code:69001-2927
Mailing Address - Country:US
Mailing Address - Phone:308-345-1429
Mailing Address - Fax:308-345-6513
Practice Address - Street 1:812 W 13TH ST
Practice Address - Street 2:
Practice Address - City:MC COOK
Practice Address - State:NE
Practice Address - Zip Code:69001-2927
Practice Address - Country:US
Practice Address - Phone:308-345-1429
Practice Address - Fax:308-345-6513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-09
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE011101YA0400X
NE393101YM0800X
NE284101YP2500X
NE103101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE100249773-00Medicaid