Provider Demographics
NPI:1619091378
Name:VILLAGE THERAPY RESOURCLES LLC
Entity Type:Organization
Organization Name:VILLAGE THERAPY RESOURCLES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TEENA
Authorized Official - Middle Name:IONNE
Authorized Official - Last Name:KENDRICK
Authorized Official - Suffix:
Authorized Official - Credentials:LMHP, CPC
Authorized Official - Phone:308-432-5437
Mailing Address - Street 1:318 SHELTON ST
Mailing Address - Street 2:
Mailing Address - City:CHADRON
Mailing Address - State:NE
Mailing Address - Zip Code:69337-2312
Mailing Address - Country:US
Mailing Address - Phone:308-432-5437
Mailing Address - Fax:308-432-5437
Practice Address - Street 1:318 SHELTON ST
Practice Address - Street 2:
Practice Address - City:CHADRON
Practice Address - State:NE
Practice Address - Zip Code:69337-2312
Practice Address - Country:US
Practice Address - Phone:308-432-5437
Practice Address - Fax:308-432-5437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1587101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025487200Medicaid