Organization
HOMEBASE COUNSELING & CONSULTING, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JUSTIN M MICKLES SR. MS (OWNER/MENTAL HEALTH THERAPIST)
(615) 853-1254
Entity
Organization
Contact information
Practice address
2001 N 35TH ST, OMAHA, NE 68111-4133
(615) 853-1254
Mailing address
5646 AMALIE DR APT F101, NASHVILLE, TN 37211-5941
(615) 853-1254
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
1485
NE
101YM0800X
Mental Health Counselor
Primary
57
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10025595100
—
NE
Enumeration date
10/23/2007
Last updated
09/28/2015
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