Healthcare Provider Details

I. General information

NPI: 1376728840
Provider Name (Legal Business Name): JOHN ENGLER PHD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2008
Last Update Date: 04/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19903 OAK ST
GRETNA NE
68028-7014
US

IV. Provider business mailing address

19903 OAK ST
GRETNA NE
68028-7014
US

V. Phone/Fax

Practice location:
  • Phone: 402-677-1559
  • Fax:
Mailing address:
  • Phone: 402-677-1559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number544
License Number StateNE

VIII. Authorized Official

Name: DR. JOHN P ENGLER
Title or Position: OWNER
Credential: PHD
Phone: 402-493-4444