Healthcare Provider Details

I. General information

NPI: 1336224971
Provider Name (Legal Business Name): BEHAVIORAL PEDIATRIC & FAMILY THERAPY PROGRAM, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 09/08/2023
Certification Date: 12/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 SOUTH 70TH STREET SUITE 200
LINCOLN NE
68506-1566
US

IV. Provider business mailing address

1520 SOUTH 70TH STREET SUITE 200
LINCOLN NE
68506-1566
US

V. Phone/Fax

Practice location:
  • Phone: 402-483-1936
  • Fax: 402-483-7314
Mailing address:
  • Phone: 402-483-1936
  • Fax: 402-483-7314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2497
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number552
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number461
License Number StateNE
# 4
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number636
License Number StateNE
# 5
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number477
License Number StateNE
# 6
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number527
License Number StateNE
# 7
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number469
License Number StateNE
# 8
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number2811
License Number StateNE
# 9
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number263
License Number StateNE

VIII. Authorized Official

Name: JAMI GIVENS
Title or Position: MEMBER
Credential: PH.D.
Phone: 402-483-1936