Basic Information
| Provider Information | |||||||||
| NPI: | 1104020718 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HAM | ||||||||
| FirstName: | RITA | ||||||||
| MiddleName: | KAY | ||||||||
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| Credential: | LMHP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 516 W F ST | ||||||||
| Address2: | |||||||||
| City: | HASTINGS | ||||||||
| State: | NE | ||||||||
| PostalCode: | 689016170 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4029843334 | ||||||||
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| Practice Location | |||||||||
| Address1: | 835 S BURLINGTON AVE | ||||||||
| Address2: | SUITE 108 | ||||||||
| City: | HASTINGS | ||||||||
| State: | NE | ||||||||
| PostalCode: | 689016912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024637711 | ||||||||
| FaxNumber: | 4024615099 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 376 | NE | X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YM0800X | 1671 | NE | X | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 376 | 01 | NE | ALCOHOL & DRUG COUNSELOR | OTHER | 1011 | 01 | NE | PROFESSIONAL COUNSELOR | OTHER | 1671 | 01 | NE | MENTAL HEALTH PRACTITIONE | OTHER |