Provider Demographics
NPI:1598891624
Name:WHITCOMB, GORDY J (LMHP LADAC)
Entity Type:Individual
Prefix:MR
First Name:GORDY
Middle Name:J
Last Name:WHITCOMB
Suffix:
Gender:M
Credentials:LMHP LADAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1481 COUNTY ROAD 29
Mailing Address - Street 2:
Mailing Address - City:TEKAMAH
Mailing Address - State:NE
Mailing Address - Zip Code:68061-5030
Mailing Address - Country:US
Mailing Address - Phone:402-374-0245
Mailing Address - Fax:
Practice Address - Street 1:1835 E MILITARY AVE
Practice Address - Street 2:SUITE 111
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-5477
Practice Address - Country:US
Practice Address - Phone:402-721-0245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE137101YA0400X
NE436101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025123300Medicaid
NE84711OtherBLUE CROSS
NE23036OtherMIDLANDS CHOICE
NE93586OtherUNITED HEALTHCARE