Provider Demographics
NPI:1003152463
Name:TRAUMA THERAPY SPECIALTIES
Entity Type:Organization
Organization Name:TRAUMA THERAPY SPECIALTIES
Other - Org Name:DEBORAH L. WINCKLER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:L
Authorized Official - Last Name:WINCKLER
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC, BCETS
Authorized Official - Phone:402-490-3672
Mailing Address - Street 1:11330 Q ST
Mailing Address - Street 2:STE # 219
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-3679
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11330 Q ST
Practice Address - Street 2:STE # 219
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-3679
Practice Address - Country:US
Practice Address - Phone:402-490-3672
Practice Address - Fax:402-597-2349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-12
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE#538101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025614700Medicaid