Provider Demographics
NPI:1538983937
Name:EMERGE BEHAVIORAL HEALTH, LLC
Entity type:Organization
Organization Name:EMERGE BEHAVIORAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMMON-LARSON
Authorized Official - Suffix:
Authorized Official - Credentials:LIMHP, PLADC
Authorized Official - Phone:308-227-1792
Mailing Address - Street 1:PO BOX 5031
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68802-5031
Mailing Address - Country:US
Mailing Address - Phone:308-227-1792
Mailing Address - Fax:
Practice Address - Street 1:223 E 14TH ST STE W150
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-3200
Practice Address - Country:US
Practice Address - Phone:308-227-1792
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-12
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health