Provider Demographics
NPI:1154570562
Name:BSM, INC.
Entity type:Organization
Organization Name:BSM, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEANNINE
Authorized Official - Middle Name:J
Authorized Official - Last Name:LANE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, BS, AA
Authorized Official - Phone:308-284-9811
Mailing Address - Street 1:PO BOX 299
Mailing Address - Street 2:
Mailing Address - City:OGALLALA
Mailing Address - State:NE
Mailing Address - Zip Code:69153-0299
Mailing Address - Country:US
Mailing Address - Phone:308-284-9811
Mailing Address - Fax:308-284-4100
Practice Address - Street 1:215 N SPRUCE ST
Practice Address - Street 2:
Practice Address - City:OGALLALA
Practice Address - State:NE
Practice Address - Zip Code:69153-2552
Practice Address - Country:US
Practice Address - Phone:308-284-9811
Practice Address - Fax:308-284-4100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-10
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE426101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE100256664-00Medicaid