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General NPI Number Information
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NPI Number | 1740797562
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Entity Type | Organization
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Legal Business Name | HAVELOCK PSYCHOTHERAPY, LLC
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Dates
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Enumeration Date | 01/02/2018
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Last Update Date | 01/02/2018
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Provider Practice Location Address
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Address Line | 6101 HAVELOCK AVE ST 2A
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City | LINCOLN
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State | NE
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Zip | 68507-1268
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Country | US
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Telephone | 402-404-6973
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Fax |
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Provider Business Mailing Address
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Address Line | 6101 HAVELOCK AVE ST 2A
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City | LINCOLN
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State | NE
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Zip | 68507-1268
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Country | US
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Telephone | 402-404-6973
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JAMES MICHAEL BOWERS
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Credential | LICSW
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Telephone | 402-404-6973
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 1667
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License Number State | NE
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 1653
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License Number State | NE
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