Provider Demographics
NPI:1134250632
Name:ADULT, ADOLESCENT AND CHILD THERAPY, INC.
Entity type:Organization
Organization Name:ADULT, ADOLESCENT AND CHILD THERAPY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER AND CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:JOHNSTON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:402-991-7441
Mailing Address - Street 1:1111 S 119TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-1601
Mailing Address - Country:US
Mailing Address - Phone:402-991-7441
Mailing Address - Fax:402-991-7445
Practice Address - Street 1:1111 S 119TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-1601
Practice Address - Country:US
Practice Address - Phone:402-991-7441
Practice Address - Fax:402-991-7445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11461041C0700X
NE28461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE240598OtherMIDLANDS CHOICE
NE100253396-00Medicaid
NE82003OtherBLUE CROSS BLUE SHIELD