Provider Demographics
NPI:1740748334
Name:CONNER PSYCHOLOGICAL SERVICES PC
Entity Type:Organization
Organization Name:CONNER PSYCHOLOGICAL SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:SHARI
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CONNER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:402-871-4474
Mailing Address - Street 1:8710 FREDERICK ST STE 101
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-3061
Mailing Address - Country:US
Mailing Address - Phone:402-871-4474
Mailing Address - Fax:402-998-5260
Practice Address - Street 1:8710 FREDERICK ST STE 101
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-3061
Practice Address - Country:US
Practice Address - Phone:402-871-4474
Practice Address - Fax:402-998-5260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-04
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025097700Medicaid