| NPI | 1073004586 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS L DIERKS Provider 402-601-8154 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NE 1025) |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2018-05-21 |
| Last Update Date | 2018-07-04 |