Provider Demographics
NPI:1639161904
Name:PRAIRIE PSYCHOLOGICAL SERVICES INC.
Entity Type:Organization
Organization Name:PRAIRIE PSYCHOLOGICAL SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TWILA
Authorized Official - Middle Name:L
Authorized Official - Last Name:PRESTON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:402-494-0040
Mailing Address - Street 1:625 E 39TH ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH SIOUX CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68776-3445
Mailing Address - Country:US
Mailing Address - Phone:402-494-0040
Mailing Address - Fax:402-494-0050
Practice Address - Street 1:625 E 39TH ST
Practice Address - Street 2:
Practice Address - City:SOUTH SIOUX CITY
Practice Address - State:NE
Practice Address - Zip Code:68776-3445
Practice Address - Country:US
Practice Address - Phone:402-494-0040
Practice Address - Fax:402-494-0050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-22
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE371101YA0400X
NE1187101YP2500X
NE1729101YP2500X
NE531103TC0700X
NE8081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025015800Medicaid
NE=========26Medicaid
NE=========OtherBCBSNE
NE10025015800Medicaid