Provider Demographics
NPI:1336224971
Name:BEHAVIORAL PEDIATRIC & FAMILY THERAPY PROGRAM, LLC
Entity type:Organization
Organization Name:BEHAVIORAL PEDIATRIC & FAMILY THERAPY PROGRAM, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JAMI
Authorized Official - Middle Name:
Authorized Official - Last Name:GIVENS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:402-483-1936
Mailing Address - Street 1:1520 SOUTH 70TH STREET
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-1566
Mailing Address - Country:US
Mailing Address - Phone:402-483-1936
Mailing Address - Fax:402-483-7314
Practice Address - Street 1:1520 SOUTH 70TH STREET
Practice Address - Street 2:SUITE 200
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-1566
Practice Address - Country:US
Practice Address - Phone:402-483-1936
Practice Address - Fax:402-483-7314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2497101YM0800X
NE552101YP2500X
NE461103G00000X
NE636103T00000X
NE477103T00000X
NE527103T00000X
NE263103T00000X
NE469103T00000X
NE2811103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47080115226Medicaid