| NPI | 1699155648 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIFFANY KODAK Executive Director 402-319-3770 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: WI 86-140) |
| Additional Taxonomies | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: NE 690) |
| Enumeration Date | 2015-06-04 |
| Last Update Date | 2015-06-04 |