MEDICARE: GREAT PLAINS MENTAL HEALTH ASSOCIATES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	111379	NE

General Provider Information

NPI Number	:	1831614064
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREAT PLAINS MENTAL HEALTH ASSOCIATES LLC

Provider Business Mailing Address
First Line	:	4610 S 133RD ST STE 109
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68137-1133
Country	:	US
Telephone Number	:	402-614-0010
Fax Number	:	402-614-0090

Provider Business Practice Location Address
First Line	:	4610 S 133RD ST STE 109
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68137-1133
Country	:	US
Telephone Number	:	402-614-0010
Fax Number	:	402-614-0090

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	PAULA A WHITTLE
Credential	:	APRN
Telephone Number	:	402-614-0010

Provider Enumeration Date	:	08/09/2017
Last Update Date	:	03/29/2018

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