Provider Demographics
NPI:1689753634
Name:CHILD AND FAMILY BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:CHILD AND FAMILY BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:GAIL
Authorized Official - Last Name:BOTHERN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:402-483-6575
Mailing Address - Street 1:7441 O ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-2468
Mailing Address - Country:US
Mailing Address - Phone:402-483-6575
Mailing Address - Fax:402-483-6587
Practice Address - Street 1:7441 O ST
Practice Address - Street 2:SUITE 300
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-2468
Practice Address - Country:US
Practice Address - Phone:402-483-6575
Practice Address - Fax:402-483-6587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE314103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE4295OtherMIDLANDS CHOICE
NE08124OtherBLUE CROSS BLUE SHIELD
NE08124OtherBLUE CROSS BLUE SHIELD