Provider Demographics
NPI:1538170709
Name:AFFILIATES IN FAMILY AND INDIVIDUAL GROWTH, INC.
Entity type:Organization
Organization Name:AFFILIATES IN FAMILY AND INDIVIDUAL GROWTH, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GINA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:HENRICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-826-5858
Mailing Address - Street 1:995 E HIGHWAY 33
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CRETE
Mailing Address - State:NE
Mailing Address - Zip Code:68333-2551
Mailing Address - Country:US
Mailing Address - Phone:402-826-5858
Mailing Address - Fax:402-826-5859
Practice Address - Street 1:995 E HIGHWAY 33
Practice Address - Street 2:SUITE 1
Practice Address - City:CRETE
Practice Address - State:NE
Practice Address - Zip Code:68333-2551
Practice Address - Country:US
Practice Address - Phone:402-826-5858
Practice Address - Fax:402-826-5859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE601101Y00000X
NE1002101Y00000X
NE7522101Y00000X
NE7525101Y00000X
NEP507101YA0400X
NE367103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========26Medicaid
NE=========26Medicaid