Provider Demographics
NPI:1225167539
Name:PECK PSYCHOTHERAPY & RESOURCE CENTER
Entity Type:Organization
Organization Name:PECK PSYCHOTHERAPY & RESOURCE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:PECK
Authorized Official - Suffix:
Authorized Official - Credentials:LMHP
Authorized Official - Phone:402-438-3037
Mailing Address - Street 1:610 J ST
Mailing Address - Street 2:SUITE 30
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68508-2967
Mailing Address - Country:US
Mailing Address - Phone:402-438-3037
Mailing Address - Fax:800-780-8312
Practice Address - Street 1:610 J ST
Practice Address - Street 2:SUITE 30
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68508-2967
Practice Address - Country:US
Practice Address - Phone:402-438-3037
Practice Address - Fax:800-780-8312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEP-307101YA0400X
NE1068101YM0800X
NE686101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025470200Medicaid
NE85071OtherBLUE CROSS