Provider Demographics
NPI:1396007241
Name:WITTENBURG, CALEB A
Entity Type:Individual
Prefix:
First Name:CALEB
Middle Name:A
Last Name:WITTENBURG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 S 17TH ST
Mailing Address - Street 2:COMMUNITY MENTAL HEALTH CENTER
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68502
Mailing Address - Country:US
Mailing Address - Phone:402-441-9224
Mailing Address - Fax:402-441-6602
Practice Address - Street 1:2201 S 17TH ST
Practice Address - Street 2:COMMUNITY MENTAL HEALTH CENTER
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68502
Practice Address - Country:US
Practice Address - Phone:402-441-9224
Practice Address - Fax:402-441-6602
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-15
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator