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General NPI Number Information
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NPI Number | 1689753634
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Entity Type | Organization
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Legal Business Name | CHILD AND FAMILY BEHAVIORAL HEALTH
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Dates
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Enumeration Date | 11/02/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 7441 O ST SUITE 300
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City | LINCOLN
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State | NE
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Zip | 68510-2468
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Country | US
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Telephone | 402-483-6575
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Fax | 402-483-6587
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Provider Business Mailing Address
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Address Line | 7441 O ST SUITE 300
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City | LINCOLN
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State | NE
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Zip | 68510-2468
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Country | US
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Telephone | 402-483-6575
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Fax | 402-483-6587
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JUDITH GAIL BOTHERN
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Credential | PH.D.
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Telephone | 402-483-6575
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 314
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License Number State | NE
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