Provider Demographics
NPI:1134733769
Name:GOOD LIFE COUNSELING & SUPPORT, LLC
Entity type:Organization
Organization Name:GOOD LIFE COUNSELING & SUPPORT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NICKY
Authorized Official - Middle Name:E
Authorized Official - Last Name:KETTLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-371-3044
Mailing Address - Street 1:PO BOX 2315
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68702-2315
Mailing Address - Country:US
Mailing Address - Phone:402-371-3044
Mailing Address - Fax:
Practice Address - Street 1:3306 RAASCH AVENUE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68702-2315
Practice Address - Country:US
Practice Address - Phone:402-371-3044
Practice Address - Fax:402-371-9643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-01
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty