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General NPI Number Information
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NPI Number | 1871267039
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Entity Type | Organization
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Legal Business Name | WOLF CHALENBURG LLC
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Dates
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Enumeration Date | 08/02/2021
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Last Update Date | 08/02/2021
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Provider Practice Location Address
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Address Line | 1620 S 70TH ST STE 105
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City | LINCOLN
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State | NE
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Zip | 68506-1563
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Country | US
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Telephone | 531-333-1149
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Fax |
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Provider Business Mailing Address
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Address Line | 2505 CHESHIRE N
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City | LINCOLN
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State | NE
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Zip | 68512-1512
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ELIZABETH CHALENBURG
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Credential | LIMHP, LADC
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Telephone | 531-333-1149
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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