Provider Demographics
NPI:1790863017
Name:SEACHORD, GARY LEE (LADC)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:LEE
Last Name:SEACHORD
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 1:920 GARDEN
Mailing Address - Street 2:
Mailing Address - City:BEATRICE
Mailing Address - State:NE
Mailing Address - Zip Code:68310
Mailing Address - Country:US
Mailing Address - Phone:402-806-0334
Mailing Address - Fax:
Practice Address - Street 1:1123 N 9TH STREET
Practice Address - Street 2:
Practice Address - City:BEATRICE
Practice Address - State:NE
Practice Address - Zip Code:68310-2041
Practice Address - Country:US
Practice Address - Phone:402-228-3386
Practice Address - Fax:402-228-2004
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NELADC502101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47052851510Medicaid
NE47052851517Medicaid
NE85334OtherBCBS
NE10025207900Medicaid
NE47052851501Medicaid
NE47052851503Medicaid
NE47052851506Medicaid
NE470528511513Medicaid
NE47052851500Medicaid
NE47052851502Medicaid
NE47052851505Medicaid
NE47052851508Medicaid
NE47052851509Medicaid
NE47052851507Medicaid
NE47052851514Medicaid
NE47052851515Medicaid
NE47052851504Medicaid
NE47052851581Medicaid