Provider Demographics
NPI:1720308968
Name:ADULTSPAN PC
Entity Type:Organization
Organization Name:ADULTSPAN PC
Other - Org Name:OUR SPOKEN LOVE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:KIPP
Authorized Official - Last Name:LANNING
Authorized Official - Suffix:
Authorized Official - Credentials:LIMHP
Authorized Official - Phone:402-429-6879
Mailing Address - Street 1:11905 P ST STE 105
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-2237
Mailing Address - Country:US
Mailing Address - Phone:402-429-6879
Mailing Address - Fax:
Practice Address - Street 1:11905 P ST STE 105
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-2237
Practice Address - Country:US
Practice Address - Phone:402-429-6879
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-10
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE735101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty