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General NPI Number Information
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NPI Number | 1225379936
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Entity Type | Organization
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Legal Business Name | BRAINWAVEBALANCE OF LINCOLN
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Dates
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Enumeration Date | 03/05/2013
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Last Update Date | 03/05/2013
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Provider Practice Location Address
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Address Line | 5930 S 58TH ST STE O
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City | LINCOLN
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State | NE
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Zip | 68516-3653
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Country | US
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Telephone | 402-904-4738
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Fax |
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Provider Business Mailing Address
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Address Line | 5930 S 58TH ST STE O
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City | LINCOLN
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State | NE
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Zip | 68516-3653
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Country | US
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Telephone | 402-904-4738
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Fax |
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Authorized Official
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Title or Position | LMHP
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Name | LAWRENCE CRIPPEN
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Credential | LMHP
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Telephone | 402-657-0312
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 1470
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License Number State | NE
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