Healthcare Provider Details

I. General information

NPI: 1447644455
Provider Name (Legal Business Name): TR HEPBURN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2015
Last Update Date: 04/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2039 Q ST #101
LINCOLN NE
68503-3643
US

IV. Provider business mailing address

2039 Q ST APT 101
LINCOLN NE
68503-3643
US

V. Phone/Fax

Practice location:
  • Phone: 402-474-2121
  • Fax: 402-477-9752
Mailing address:
  • Phone: 402-474-2121
  • Fax: 402-477-9752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number StateNE
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ROBERT FREDERICK HEPBURN
Title or Position: CEO/CO OWNER
Credential:
Phone: 402-474-2121