Provider Demographics
NPI:1124200670
Name:PSYCHIATRIC MENTAL HEALTHCARE PC
Entity type:Organization
Organization Name:PSYCHIATRIC MENTAL HEALTHCARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:EASLEY
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:402-354-8035
Mailing Address - Street 1:9239 WEST CENTER RD
Mailing Address - Street 2:SUITE 222
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124
Mailing Address - Country:US
Mailing Address - Phone:402-354-8035
Mailing Address - Fax:402-354-8044
Practice Address - Street 1:9239 WEST CENTER RD
Practice Address - Street 2:SUITE 222
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124
Practice Address - Country:US
Practice Address - Phone:402-354-8035
Practice Address - Fax:402-354-8044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-27
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11089163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, AdultGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========26Medicaid
099147Medicare PIN
NE=========26Medicaid