| NPI | 1164808994 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TOMEKA C JOHNSON Credentialing Manager 402-885-7672 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: NE 10597) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE 1831) |
| Enumeration Date | 2015-08-04 |
| Last Update Date | 2017-11-01 |