Healthcare Provider Details

I. General information

NPI: 1326187493
Provider Name (Legal Business Name): PANHANDLE MENTAL HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 02/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

941 8TH AVE
SIDNEY NE
69162-1736
US

IV. Provider business mailing address

4110 AVENUE D
SCOTTSBLUFF NE
69361-4650
US

V. Phone/Fax

Practice location:
  • Phone: 308-254-2649
  • Fax: 308-254-1014
Mailing address:
  • Phone: 308-635-3171
  • Fax: 308-635-7026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberSATC096
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: LAURA RICHARDS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 308-635-3171