Organization
SACRED GROUND PSYCHOTHERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JONATHAN MARCOTTE (SELF PHD)
(402) 783-1555
Entity
Organization
Contact information
Practice address
4535 NORMAL BLVD STE 201, LINCOLN, NE 68506-2891
(402) 421-1182
Mailing address
4535 NORMAL BLVD STE 201, LINCOLN, NE 68506-2891
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5348694785
—
NE
Enumeration date
05/24/2019
Last updated
05/24/2019
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