Organization
SHANE CROCKETT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SHANE MAYNARD CROCKETT LIMHP,LMHP (PSYCHOTHERAPIST)
(402) 488-1032
Entity
Organization
Contact information
Practice address
8101 'O' STREET, SUITE 214, LINCOLN, NE 68510-2647
(402) 488-1032
(402) 484-8545
Mailing address
8101 'O' STREET, SUITE 214, LINCOLN, NE 68510-2647
(402) 488-1032
(402) 484-8545
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
834
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100251092-00
—
NE
Enumeration date
02/10/2012
Last updated
02/10/2012
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