Provider Demographics
NPI:1700171741
Name:PANDO GERIATRIC COUNSELING, PC
Entity Type:Organization
Organization Name:PANDO GERIATRIC COUNSELING, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MINDY
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:CROUCH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LIMHP
Authorized Official - Phone:402-321-8995
Mailing Address - Street 1:10806 PRAIRIE HILLS DR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-4830
Mailing Address - Country:US
Mailing Address - Phone:402-321-8995
Mailing Address - Fax:
Practice Address - Street 1:10806 PRAIRIE HILLS DR
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-4830
Practice Address - Country:US
Practice Address - Phone:402-321-8995
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-17
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health