Provider Demographics
NPI:1285221572
Name:PARADIS PRACTICE, PC
Entity Type:Organization
Organization Name:PARADIS PRACTICE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:PARADIS
Authorized Official - Suffix:
Authorized Official - Credentials:LIMHP
Authorized Official - Phone:402-566-5860
Mailing Address - Street 1:10831 OLD MILL RD STE 200G
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-2640
Mailing Address - Country:US
Mailing Address - Phone:402-566-5860
Mailing Address - Fax:402-322-7681
Practice Address - Street 1:10831 OLD MILL RD STE 200G
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-2640
Practice Address - Country:US
Practice Address - Phone:402-566-5860
Practice Address - Fax:402-322-7681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-21
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty