Individual
MR. ERIC S THOMALLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LADC805
Contact information
Practice address
543 N LINDEN ST, BLUE VALLEY BEHAVIORAL HEALTH, WAHOO, NE 68066-1960
(402) 443-4414
(402) 443-3462
Mailing address
543 N LINDEN ST, BLUE VALLEY BEHAVIORAL HEALTH, WAHOO, NE 68066-1960
(402) 443-4414
(402) 443-3462
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10025208000
—
NE
05
—
10025208700
—
NE
05
—
47052851502
—
NE
05
—
47052851504
—
NE
Enumeration date
11/16/2006
Last updated
08/06/2009
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