Provider Demographics
NPI:1770503047
Name:BYRNS, JUDY E (PHD, LP)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:E
Last Name:BYRNS
Suffix:
Gender:F
Credentials:PHD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 PIONEERS BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68502-5963
Mailing Address - Country:US
Mailing Address - Phone:402-489-9959
Mailing Address - Fax:402-489-2219
Practice Address - Street 1:3201 PIONEERS BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68502-5963
Practice Address - Country:US
Practice Address - Phone:402-489-9959
Practice Address - Fax:402-489-2219
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE289103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE98158OtherBLUE CROSS BLUE SHIELD AU
IA0587832Medicaid
NE80003614113Medicaid
NE08168OtherBLUE CROSS BLUE SHIELD
NE5162OtherMIDLANDS CHOICE
NE80003614126Medicaid
NE275885Medicare ID - Type Unspecified
NE5162OtherMIDLANDS CHOICE