Healthcare Provider Details

I. General information

NPI: 1114411014
Provider Name (Legal Business Name): DYNAMIC LEARNING INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2018
Last Update Date: 09/16/2021
Certification Date: 09/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6105 LAROCHE RD
LINCOLN NE
68526-6058
US

IV. Provider business mailing address

6105 LAROCHE RD
LINCOLN NE
68526-6058
US

V. Phone/Fax

Practice location:
  • Phone: 402-326-3339
  • Fax: 531-500-0576
Mailing address:
  • Phone: 402-326-3339
  • Fax: 531-500-0576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. CARLOS NOEL FREEMAN
Title or Position: FOUNDER & PRESIDENT
Credential: PH.D., BCBA-D
Phone: 402-326-3339