| NPI | 1801292321 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY LYNN FAIRBANKS Manager/Director 402-417-8793 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NE 748) |
| Enumeration Date | 2014-11-11 |
| Last Update Date | 2014-11-11 |