Basic Information
Provider Information
NPI: 1154520278
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HERBER
FirstName: BECKY
MiddleName: J
NamePrefix: MS.
NameSuffix:  
Credential: LMHC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 13010 JAYNES CIR
Address2:  
City: OMAHA
State: NE
PostalCode: 68164
CountryCode: US
TelephoneNumber: 4026604252
FaxNumber: 7123226833
Practice Location
Address1: 515 E BROADWAY
Address2:  
City: COUNCIL BLUFFS
State: IA
PostalCode: 515034419
CountryCode: US
TelephoneNumber: 7123221407
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/18/2007
LastUpdateDate: 07/18/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800XLMHC01003IAY Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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