Healthcare Provider Details

I. General information

NPI: 1417542630
Provider Name (Legal Business Name): DEFY THE CYCLE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2021
Last Update Date: 03/09/2021
Certification Date: 03/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4535 NORMAL BLVD STE 295
LINCOLN NE
68506-2890
US

IV. Provider business mailing address

4535 NORMAL BLVD STE 295
LINCOLN NE
68506-2890
US

V. Phone/Fax

Practice location:
  • Phone: 402-853-6686
  • Fax: 888-972-3644
Mailing address:
  • Phone: 402-853-6686
  • Fax: 888-972-3644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: AMBER ZEISLER
Title or Position: PSYCHOLOGIST
Credential: PSYD
Phone: 402-853-6686