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General NPI Number Information
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NPI Number | 1407479884
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Entity Type | Organization
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Legal Business Name | WILD FIG PSYCHOTHERAPY, LLC
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Dates
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Enumeration Date | 05/20/2020
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Last Update Date | 05/20/2020
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Provider Practice Location Address
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Address Line | 1610 S 70TH ST
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City | LINCOLN
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State | NE
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Zip | 68506-1565
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Country | US
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Telephone | 402-639-7855
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Fax |
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Provider Business Mailing Address
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Address Line | 1928 F ST
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City | LINCOLN
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State | NE
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Zip | 68510-2836
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/MENTAL HEALTH COUNSELOR
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Name | JAMIE KEETON
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Credential |
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Telephone | 402-639-7855
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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