Provider Demographics
NPI:1841431541
Name:CHMP LLC
Entity Type:Organization
Organization Name:CHMP LLC
Other - Org Name:CHOICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHANDRA
Authorized Official - Middle Name:M
Authorized Official - Last Name:PETERSEN
Authorized Official - Suffix:
Authorized Official - Credentials:LMHP LADC
Authorized Official - Phone:402-533-3680
Mailing Address - Street 1:PO BOX 589
Mailing Address - Street 2:
Mailing Address - City:BLAIR
Mailing Address - State:NE
Mailing Address - Zip Code:68008-0589
Mailing Address - Country:US
Mailing Address - Phone:402-533-3680
Mailing Address - Fax:402-533-4411
Practice Address - Street 1:1630 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BLAIR
Practice Address - State:NE
Practice Address - Zip Code:68008-1656
Practice Address - Country:US
Practice Address - Phone:402-533-3680
Practice Address - Fax:402-533-4411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-10
Last Update Date:2009-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE731101YA0400X
NE2997101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty