Provider Demographics
NPI:1013457936
Name:COUNCILL PSYCHIATRIC CARE SPECIALISTS
Entity Type:Organization
Organization Name:COUNCILL PSYCHIATRIC CARE SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:G
Authorized Official - Last Name:COUNCILL
Authorized Official - Suffix:III
Authorized Official - Credentials:APRN
Authorized Official - Phone:402-676-9232
Mailing Address - Street 1:919 GALVIN RD S
Mailing Address - Street 2:SUITE A
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68005-2286
Mailing Address - Country:US
Mailing Address - Phone:402-881-0678
Mailing Address - Fax:402-625-0664
Practice Address - Street 1:1102 ROLAND DR
Practice Address - Street 2:
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-6167
Practice Address - Country:US
Practice Address - Phone:402-676-9232
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-24
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE55568261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health