Provider Demographics
NPI:1538351523
Name:LYNN BEIDECK RECOVERY BEHAVIORAL HEALTH
Entity type:Organization
Organization Name:LYNN BEIDECK RECOVERY BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:R
Authorized Official - Last Name:BEIDECK
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMHP, LADC, CPC
Authorized Official - Phone:402-560-9558
Mailing Address - Street 1:1203 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68502-4560
Mailing Address - Country:US
Mailing Address - Phone:402-560-9558
Mailing Address - Fax:402-742-6486
Practice Address - Street 1:2535 S 10TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68502-3451
Practice Address - Country:US
Practice Address - Phone:402-560-9558
Practice Address - Fax:402-742-6486
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LYNN BEIDECK
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-14
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3175101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty