=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093591463
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ACME BEHAVIORAL HEALTH, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/01/2023
-----------------------------------------------------
Last Update Date | 09/01/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 835 S BURLINGTON AVE STE 106
-----------------------------------------------------
City | HASTINGS
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68901-6928
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-519-4382
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 835 S BURLINGTON AVE STE 106
-----------------------------------------------------
City | HASTINGS
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68901-6928
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-519-4382
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | CATHY KLEIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 402-519-4382
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------