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General NPI Number Information
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NPI Number | 1811441991
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Entity Type | Organization
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Legal Business Name | STANLEY R CARLOCK ED D LLC
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Dates
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Enumeration Date | 08/06/2016
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Last Update Date | 09/07/2016
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Provider Practice Location Address
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Address Line | 1001 S 70TH ST STE 107
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City | LINCOLN
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State | NE
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Zip | 68510-7901
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Country | US
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Telephone | 402-483-0051
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Fax |
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Provider Business Mailing Address
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Address Line | 1001 S 70TH ST STE 107
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City | LINCOLN
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State | NE
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Zip | 68510-7901
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Country | US
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Telephone | 402-483-0051
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | STANLEY CARLOCK
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Credential | EDD
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Telephone | 402-483-0051
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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 | 602
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License Number State | NE
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