Provider Demographics
NPI:1073945739
Name:BEHAVEN KIDS-LINCOLN
Entity Type:Organization
Organization Name:BEHAVEN KIDS-LINCOLN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:KATHLEEN
Authorized Official - Last Name:BEECHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-676-2069
Mailing Address - Street 1:1145 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68502-4440
Mailing Address - Country:US
Mailing Address - Phone:402-423-6464
Mailing Address - Fax:
Practice Address - Street 1:1145 HIGH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68502-4440
Practice Address - Country:US
Practice Address - Phone:402-423-6464
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-05
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NECDHS201301251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health