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General NPI Number Information
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NPI Number | 1619322542
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Entity Type | Organization
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Legal Business Name | LINCOLN KARATE CLINIC, INC.
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Dates
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Enumeration Date | 04/28/2016
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Last Update Date | 04/28/2016
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Provider Practice Location Address
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Address Line | 237 S 70TH ST SUITE: 108
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City | LINCOLN
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State | NE
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Zip | 68510-2473
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Country | US
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Telephone | 402-430-6912
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Fax |
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Provider Business Mailing Address
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Address Line | 237 S 70TH ST SUITE: 108
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City | LINCOLN
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State | NE
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Zip | 68510-2473
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Country | US
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Telephone | 402-430-6912
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | SCOTT DAVID WALLS
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Credential | MA, LIPC, CCMHC
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Telephone | 402-430-6912
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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 | 244
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License Number State | NE
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