Basic Information
Provider Information | |||||||||
NPI: | 1891074704 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | OASIS COUNSELING INTERNATIONAL | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 333 W NORFOLK AVE | ||||||||
Address2: | SUITE 201 | ||||||||
City: | NORFOLK | ||||||||
State: | NE | ||||||||
PostalCode: | 687015221 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4023792030 | ||||||||
FaxNumber: | 4023793933 | ||||||||
Practice Location | |||||||||
Address1: | 221 W DOUGLAS ST | ||||||||
Address2: |   | ||||||||
City: | ONEILL | ||||||||
State: | NE | ||||||||
PostalCode: | 687631715 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4023363009 | ||||||||
FaxNumber: | 4023361249 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/09/2011 | ||||||||
LastUpdateDate: | 06/20/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | STORTVEDT | ||||||||
AuthorizedOfficialFirstName: | MARK | ||||||||
AuthorizedOfficialMiddleName: | E | ||||||||
AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
AuthorizedOfficialTelephone: | 40237920301 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | LMHP | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X |   | NE | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 103TC0700X |   | NE | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Clinical | 101YM0800X |   | NE | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
ID | Type | State | Issuer | Description | 96104 | 01 | NE | BLUE CROSS/BLUE SHIELD | OTHER |