Basic Information
| Provider Information | |||||||||
| NPI: | 1063717973 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STAHLECKER | ||||||||
| FirstName: | REBECCA | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | LIMHP, LADC, LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1800 W PASEWALK AVE | ||||||||
| Address2: | |||||||||
| City: | NORFOLK | ||||||||
| State: | NE | ||||||||
| PostalCode: | 687015656 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4025006870 | ||||||||
| FaxNumber: | 4025006871 | ||||||||
| Practice Location | |||||||||
| Address1: | 3805 25TH ST STE A | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | NE | ||||||||
| PostalCode: | 686012233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4025006870 | ||||||||
| FaxNumber: | 4025006871 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2011 | ||||||||
| LastUpdateDate: | 02/03/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 1045 | NE | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YP2500X | 2096 | NE | N | Behavioral Health & Social Service Providers | Counselor | Professional | 101YM0800X | 1422 | NE | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 470831659-26 | 05 | NE | MEDICAID |