Provider Demographics
NPI:1760771075
Name:HUSKE, TIM SCOTT (LADC)
Entity Type:Individual
Prefix:
First Name:TIM
Middle Name:SCOTT
Last Name:HUSKE
Suffix:
Gender:M
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 GATEWAY MALL
Mailing Address - Street 2:GREENTREE COURT, SUITE 342
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68505-2489
Mailing Address - Country:US
Mailing Address - Phone:402-434-2730
Mailing Address - Fax:402-441-9287
Practice Address - Street 1:210 GATEWAY MALL
Practice Address - Street 2:GREENTREE COURT, SUITE 342
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68505-2489
Practice Address - Country:US
Practice Address - Phone:402-434-2730
Practice Address - Fax:402-441-9287
Is Sole Proprietor?:No
Enumeration Date:2011-04-07
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE903101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47075636930Medicaid
345680000OtherMAGELLAN
99037OtherBLUE CROSS BLUE SHIELD