Provider Demographics
NPI:1881072445
Name:MIDWEST ENCOURAGEMENT & COUNSELING CENTER LLC
Entity type:Organization
Organization Name:MIDWEST ENCOURAGEMENT & COUNSELING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JODY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:ANGEL-TREJO
Authorized Official - Suffix:
Authorized Official - Credentials:LIMHP
Authorized Official - Phone:308-236-0500
Mailing Address - Street 1:P. O. BOX 1686
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68848
Mailing Address - Country:US
Mailing Address - Phone:308-224-0596
Mailing Address - Fax:308-237-5225
Practice Address - Street 1:220 W. 15TH ST
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845-6763
Practice Address - Country:US
Practice Address - Phone:308-224-0596
Practice Address - Fax:308-237-5225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-14
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE4168251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026307400Medicaid