Healthcare Provider Details

I. General information

NPI: 1417893900
Provider Name (Legal Business Name): BENJAMIN GEORGE BARTHOLOW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: BEN BARTHOLOW

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 N VICTORY RD
NORFOLK NE
68701-6859
US

IV. Provider business mailing address

1700 N VICTORY RD
NORFOLK NE
68701-6859
US

V. Phone/Fax

Practice location:
  • Phone: 402-370-3361
  • Fax:
Mailing address:
  • Phone: 402-370-3361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: