Healthcare Provider Details

I. General information

NPI: 1881576668
Provider Name (Legal Business Name): BOYD CLIFTON SHORT JR. CHAPLAIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2025
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 WOOLWORTH AVE BLDG 1
OMAHA NE
68105-1850
US

IV. Provider business mailing address

4101 WOOLWORTH AVE BLDG 1
OMAHA NE
68105-1850
US

V. Phone/Fax

Practice location:
  • Phone: 402-995-3128
  • Fax:
Mailing address:
  • Phone: 402-995-3128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: