Provider Demographics
NPI:1740797562
Name:HAVELOCK PSYCHOTHERAPY, LLC
Entity Type:Organization
Organization Name:HAVELOCK PSYCHOTHERAPY, LLC
Other - Org Name:JAMES MICHAEL BOWERS, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BOWERS
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:402-404-6973
Mailing Address - Street 1:6101 HAVELOCK AVE ST 2A
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68507-1268
Mailing Address - Country:US
Mailing Address - Phone:402-404-6973
Mailing Address - Fax:
Practice Address - Street 1:6101 HAVELOCK AVE ST 2A
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68507-1268
Practice Address - Country:US
Practice Address - Phone:402-404-6973
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-02
Last Update Date:2018-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1667104100000X
NE16531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty