Healthcare Provider Details

I. General information

NPI: 1306919881
Provider Name (Legal Business Name): FIRST STEP RECOVERY CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 08/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 S 68TH STREET PL SUITE 500
LINCOLN NE
68510-2475
US

IV. Provider business mailing address

300 S 68TH STREET PL SUITE 500
LINCOLN NE
68510-2475
US

V. Phone/Fax

Practice location:
  • Phone: 402-434-2730
  • Fax: 402-434-3970
Mailing address:
  • Phone: 402-434-2730
  • Fax: 402-434-3970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberSATC221
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberSATC221
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberSATC221
License Number StateNE
# 4
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberSATC221
License Number StateNE
# 5
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License NumberSATC221
License Number StateNE
# 6
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberSATC221
License Number StateNE
# 7
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License NumberSATC221
License Number StateNE
# 8
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License NumberSATC221
License Number StateNE
# 9
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License NumberSATC221
License Number StateNE

VIII. Authorized Official

Name: MR. JARED W RAY
Title or Position: DIRECTOR/OPERATIONS COORDINATOR
Credential: MA
Phone: 402-434-2730