Healthcare Provider Details

I. General information

NPI: 1790863017
Provider Name (Legal Business Name): GARY LEE SEACHORD LADC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1123 N 9TH STREET
BEATRICE NE
68310-2041
US

IV. Provider business mailing address

920 GARDEN
BEATRICE NE
68310
US

V. Phone/Fax

Practice location:
  • Phone: 402-228-3386
  • Fax: 402-228-2004
Mailing address:
  • Phone: 402-806-0334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLADC502
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: