Provider Demographics
NPI:1598972994
Name:PANHANDLE MENTAL HEALTH CENTER
Entity Type:Organization
Organization Name:PANHANDLE MENTAL HEALTH CENTER
Other - Org Name:PMHC-REACH OUT FOSTER CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHARYN
Authorized Official - Middle Name:
Authorized Official - Last Name:WOHLERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-635-3171
Mailing Address - Street 1:4110 AVENUE D
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69361-4650
Mailing Address - Country:US
Mailing Address - Phone:308-635-3171
Mailing Address - Fax:308-635-7026
Practice Address - Street 1:410 SOUTH BELTLINE
Practice Address - Street 2:SUITE 3
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361
Practice Address - Country:US
Practice Address - Phone:308-632-1450
Practice Address - Fax:308-632-1454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE83829871251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========26Medicaid