Healthcare Provider Details

I. General information

NPI: 1316185812
Provider Name (Legal Business Name): BEHAVIORAL MEDICINE CLINIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2009
Last Update Date: 01/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 D ST STE 2
FAIRBURY NE
68352-2318
US

IV. Provider business mailing address

510 D ST STE 2
FAIRBURY NE
68352-2318
US

V. Phone/Fax

Practice location:
  • Phone: 402-729-6379
  • Fax: 402-729-4094
Mailing address:
  • Phone: 402-729-6379
  • Fax: 402-729-4094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number439
License Number StateNE

VIII. Authorized Official

Name: DR. ALLEN E MEYER
Title or Position: PSYCHOLOGIST
Credential: PH.D.
Phone: 402-729-6379