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General NPI Number Information
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NPI Number | 1962762195
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Entity Type | Organization
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Legal Business Name | WILLIAMSBURG BEHAVIORAL PSYCHOLOGY, LLC
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Dates
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Enumeration Date | 05/22/2012
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Last Update Date | 05/22/2012
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Provider Practice Location Address
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Address Line | 3801 UNION DR STE 206
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City | LINCOLN
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State | NE
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Zip | 68516-6652
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Country | US
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Telephone | 402-489-2218
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Fax | 402-489-3666
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Provider Business Mailing Address
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Address Line | 3801 UNION DR STE 206
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City | LINCOLN
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State | NE
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Zip | 68516-6652
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Country | US
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Telephone | 402-489-2218
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Fax | 402-489-3666
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | CARYLL PLAMER WILSON
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Credential | PH.D.
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Telephone | 402-489-2218
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 766
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License Number State | NE
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 261
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License Number State | NE
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 528
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License Number State | NE
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