Provider Demographics
NPI:1558347468
Name:CHLEBORAD, PAUL ERVIN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ERVIN
Last Name:CHLEBORAD
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 S 4TH ST STE 222
Mailing Address - Street 2:PO BOX 223
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
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE561103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE08466OtherBLUE CROSS BLUE SHIELD
NE47081389126Medicaid
NE234143OtherMIDLANDS CHOICE
NE08466OtherBLUE CROSS BLUE SHIELD