| NPI | 1669612503 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JERRY ALAN VAN WINKLE Psychologist 308-224-4664 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NE 577) |
| Additional Taxonomies | 251S00000X (Licence: NE 577) |
| Enumeration Date | 2009-03-05 |
| Last Update Date | 2014-04-24 |