Provider Demographics
NPI:1568463958
Name:PSYCHOTHERAPY ASSOCIATES OF LANCASTER COUNTY, PC
Entity Type:Organization
Organization Name:PSYCHOTHERAPY ASSOCIATES OF LANCASTER COUNTY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:S
Authorized Official - Last Name:BONACKER
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:402-475-5069
Mailing Address - Street 1:1919 S 40TH STREET
Mailing Address - Street 2:SUITE 312
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506
Mailing Address - Country:US
Mailing Address - Phone:402-475-5069
Mailing Address - Fax:402-475-2350
Practice Address - Street 1:1919 S 40TH STREET
Practice Address - Street 2:SUITE 312
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506
Practice Address - Country:US
Practice Address - Phone:402-475-5069
Practice Address - Fax:402-475-2350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE271106920101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========13Medicare ID - Type Unspecified
NE095576Medicare ID - Type Unspecified