=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629705892
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MCDEVITT BEHAVIORAL HEALTH, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/06/2022
-----------------------------------------------------
Last Update Date | 08/06/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7130 S 29TH ST STE G
-----------------------------------------------------
City | LINCOLN
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68516-5841
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-413-6537
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7130 S 29TH ST STE G
-----------------------------------------------------
City | LINCOLN
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68516-5841
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-413-6537
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | JESSICA MCDEVITT
-----------------------------------------------------
Credential | LIMHP, LADC
-----------------------------------------------------
Telephone | 402-677-6716
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------