Provider Demographics
NPI:1083283360
Name:SECOND CHANCES PSYCHOTHERAPY, LLC
Entity Type:Organization
Organization Name:SECOND CHANCES PSYCHOTHERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:IRENE
Authorized Official - Last Name:CORNISH
Authorized Official - Suffix:
Authorized Official - Credentials:LIMHP, PLADC
Authorized Official - Phone:402-405-1171
Mailing Address - Street 1:140 N 8TH ST STE 430
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68508-1359
Mailing Address - Country:US
Mailing Address - Phone:402-405-1171
Mailing Address - Fax:
Practice Address - Street 1:140 N 8TH ST STE 430
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68508-1359
Practice Address - Country:US
Practice Address - Phone:402-405-1171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-22
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty