Provider Demographics
NPI:1467823260
Name:INKBLOTS COUNSELING LLC
Entity type:Organization
Organization Name:INKBLOTS COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:GERRIT
Authorized Official - Last Name:LASKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:402-640-4779
Mailing Address - Street 1:208 N 5TH ST STE C
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-4155
Mailing Address - Country:US
Mailing Address - Phone:402-640-4779
Mailing Address - Fax:402-564-7735
Practice Address - Street 1:208 N 5TH ST STE C
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-4155
Practice Address - Country:US
Practice Address - Phone:402-640-4779
Practice Address - Fax:402-564-7735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-19
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE604103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty