Provider Demographics
NPI:1730517228
Name:UNIFIED THERAPY CLINIC, P.C.
Entity type:Organization
Organization Name:UNIFIED THERAPY CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WIEMERS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:308-345-4884
Mailing Address - Street 1:212 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:MC COOK
Mailing Address - State:NE
Mailing Address - Zip Code:69001-3712
Mailing Address - Country:US
Mailing Address - Phone:308-345-4884
Mailing Address - Fax:308-345-2366
Practice Address - Street 1:212 E 1ST ST
Practice Address - Street 2:
Practice Address - City:MC COOK
Practice Address - State:NE
Practice Address - Zip Code:69001-3712
Practice Address - Country:US
Practice Address - Phone:308-345-4884
Practice Address - Fax:308-345-2366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-22
Last Update Date:2017-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health