Provider Demographics
NPI:1780235143
Name:MENTAL WELLNESS COUNSELING SERVICES, LLC
Entity type:Organization
Organization Name:MENTAL WELLNESS COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAELA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MASTNY
Authorized Official - Suffix:
Authorized Official - Credentials:LMHP, LCSW
Authorized Official - Phone:402-547-8869
Mailing Address - Street 1:11605 W DODGE RD STE 4
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-2566
Mailing Address - Country:US
Mailing Address - Phone:402-547-8869
Mailing Address - Fax:
Practice Address - Street 1:8031 W CENTER RD STE 307
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-3134
Practice Address - Country:US
Practice Address - Phone:425-331-9088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEAPPLYINGMedicaid