Provider Demographics
NPI:1831614064
Name:GREAT PLAINS MENTAL HEALTH ASSOCIATES LLC
Entity type:Organization
Organization Name:GREAT PLAINS MENTAL HEALTH ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:A
Authorized Official - Last Name:WHITTLE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:402-614-0010
Mailing Address - Street 1:4610 S 133RD ST STE 109
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-1133
Mailing Address - Country:US
Mailing Address - Phone:402-614-0010
Mailing Address - Fax:402-614-0090
Practice Address - Street 1:4610 S 133RD ST STE 109
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-1133
Practice Address - Country:US
Practice Address - Phone:402-614-0010
Practice Address - Fax:402-614-0090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-09
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE111379106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty