Provider Demographics
NPI:1265662118
Name:HEARTLAND PSYCHOLOGISTS LLC
Entity Type:Organization
Organization Name:HEARTLAND PSYCHOLOGISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:LUEBBERT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:402-891-2340
Mailing Address - Street 1:11414 W CENTER RD
Mailing Address - Street 2:SUITE 243
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-4486
Mailing Address - Country:US
Mailing Address - Phone:402-333-8210
Mailing Address - Fax:402-333-2298
Practice Address - Street 1:11414 W CENTER RD
Practice Address - Street 2:SUITE 243
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-4486
Practice Address - Country:US
Practice Address - Phone:402-333-8210
Practice Address - Fax:402-333-2298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-24
Last Update Date:2009-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE567103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025764500Medicaid