Healthcare Provider Details

I. General information

NPI: 1194891499
Provider Name (Legal Business Name): SAINT FRANCIS STUDENT WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2124 N LAFAYETTE AVE
GRAND ISLAND NE
68803-2048
US

IV. Provider business mailing address

2124 N LAFAYETTE AVE
GRAND ISLAND NE
68803-2048
US

V. Phone/Fax

Practice location:
  • Phone: 308-384-2265
  • Fax: 308-384-2243
Mailing address:
  • Phone: 308-384-2265
  • Fax: 308-384-2243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number2790
License Number StateNE

VIII. Authorized Official

Name: MRS. EMELISE DIANE BAUGHMAN
Title or Position: MH SA COUNSELOR
Credential: MED LMHP LADC
Phone: 308-384-2265