Provider Demographics
NPI:1417227240
Name:PEACE PRACTICE PSYCHOLOGY CENTER PC
Entity type:Organization
Organization Name:PEACE PRACTICE PSYCHOLOGY CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:SUSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROMANIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-496-9966
Mailing Address - Street 1:1919 S 40TH ST
Mailing Address - Street 2:STE 111
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-5243
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1919 S 40TH ST
Practice Address - Street 2:STE 111
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-5243
Practice Address - Country:US
Practice Address - Phone:402-488-3037
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-10
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization