Provider Demographics
NPI:1184635047
Name:ORIGINS BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:ORIGINS BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:TRICIA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:MONZON
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:402-429-1425
Mailing Address - Street 1:650 J ST
Mailing Address - Street 2:SUITE 401, THE MILL TOWNE BUILDING
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68508-2900
Mailing Address - Country:US
Mailing Address - Phone:402-477-8198
Mailing Address - Fax:
Practice Address - Street 1:650 J ST
Practice Address - Street 2:SUITE 401, THE MILL TOWNE BUILDING
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68508-2900
Practice Address - Country:US
Practice Address - Phone:402-477-8198
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEP-208101YA0400X
NE395101YA0400X
NE2222101YM0800X
NE2504101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE100253331-00Medicaid