Provider Demographics
NPI:1508265802
Name:GUETHLEIN PSYCHOLOGICAL SERVICES LLC
Entity Type:Organization
Organization Name:GUETHLEIN PSYCHOLOGICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CORFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-534-8383
Mailing Address - Street 1:108 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-5430
Mailing Address - Country:US
Mailing Address - Phone:308-534-8383
Mailing Address - Fax:308-534-6570
Practice Address - Street 1:108 E 2ND ST
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-5430
Practice Address - Country:US
Practice Address - Phone:308-534-8383
Practice Address - Fax:308-534-6570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-22
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE497101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026071100Medicaid