Healthcare Provider Details

I. General information

NPI: 1821921370
Provider Name (Legal Business Name): WILLIAM TRYON PLADC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2205 OSBORNE DR E
HASTINGS NE
68901-2633
US

IV. Provider business mailing address

2205 OSBORNE DR E
HASTINGS NE
68901-2633
US

V. Phone/Fax

Practice location:
  • Phone: 402-462-2066
  • Fax: 402-462-2045
Mailing address:
  • Phone: 402-462-2066
  • Fax: 402-462-2045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberP-2430
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: