Provider Demographics
NPI:1386305936
Name:SAFE PLACE THERAPY SERVICES, LLC
Entity type:Organization
Organization Name:SAFE PLACE THERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ADRIANA
Authorized Official - Middle Name:PATRICIA
Authorized Official - Last Name:FEGENBUSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-899-0242
Mailing Address - Street 1:13304 W CENTER RD STE 203
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-3453
Mailing Address - Country:US
Mailing Address - Phone:712-899-0242
Mailing Address - Fax:712-899-0242
Practice Address - Street 1:13304 W CENTER RD STE 203
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-3453
Practice Address - Country:US
Practice Address - Phone:712-899-0242
Practice Address - Fax:712-899-0242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-05
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty