Provider Demographics
NPI:1104552892
Name:ADULTSPAN PC
Entity type:Organization
Organization Name:ADULTSPAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:KIPP
Authorized Official - Last Name:LANNING
Authorized Official - Suffix:
Authorized Official - Credentials:LIMHP
Authorized Official - Phone:402-429-6879
Mailing Address - Street 1:1001 S 70TH STREET
Mailing Address - Street 2:SUITE 225
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-7906
Mailing Address - Country:US
Mailing Address - Phone:402-429-6879
Mailing Address - Fax:
Practice Address - Street 1:1001 S 70TH STREET
Practice Address - Street 2:SUITE 225
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-7906
Practice Address - Country:US
Practice Address - Phone:402-429-6879
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADULTSPAN PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-07-26
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty