Provider Demographics
NPI:1710084223
Name:TED KAWA CHILD & FAMILY COUNSELING PC
Entity Type:Organization
Organization Name:TED KAWA CHILD & FAMILY COUNSELING PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TED
Authorized Official - Middle Name:
Authorized Official - Last Name:KAWA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:308-389-6160
Mailing Address - Street 1:1811 W 2ND STREET
Mailing Address - Street 2:SUITE 435
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-5413
Mailing Address - Country:US
Mailing Address - Phone:308-389-6160
Mailing Address - Fax:308-381-0658
Practice Address - Street 1:1811 W 2ND STREET
Practice Address - Street 2:SUITE 435
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-5413
Practice Address - Country:US
Practice Address - Phone:308-389-6160
Practice Address - Fax:308-381-0658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-19
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025283400Medicaid
NE099732Medicare ID - Type Unspecified