Provider Demographics
NPI:1801650510
Name:CODY LEE COUNSELING LLC
Entity type:Organization
Organization Name:CODY LEE COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CODY
Authorized Official - Middle Name:
Authorized Official - Last Name:BONERTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-881-5046
Mailing Address - Street 1:706 N 129TH ST STE 113
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-6116
Mailing Address - Country:US
Mailing Address - Phone:402-413-5562
Mailing Address - Fax:
Practice Address - Street 1:706 N 129TH ST STE 113
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-6116
Practice Address - Country:US
Practice Address - Phone:402-413-5562
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-13
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty