| NPI | 1396018198 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANE MAYNARD CROCKETT Psychotherapist 402-488-1032 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: NE 834) |
| Enumeration Date | 2012-02-10 |
| Last Update Date | 2012-02-10 |