Provider Demographics
NPI:1275793473
Name:NORFOLK PSYCHOLOGICAL SERVICES
Entity Type:Organization
Organization Name:NORFOLK PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:CHLEBORAD
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:402-379-0448
Mailing Address - Street 1:125 S 4TH ST STE 222
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-5200
Mailing Address - Country:US
Mailing Address - Phone:402-379-0448
Mailing Address - Fax:402-379-0448
Practice Address - Street 1:125 S 4TH ST STE 222
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-5200
Practice Address - Country:US
Practice Address - Phone:402-379-0448
Practice Address - Fax:402-379-0448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-11
Last Update Date:2011-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========26Medicaid