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Organization

SHANE CROCKETT

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. SHANE MAYNARD CROCKETT LIMHP (MENTAL HEALTH THERAPIST)
(402) 484-0444
Entity
Organization

Contact information

Practice address
8101 O ST, SUITE 118, LINCOLN, NE 68510-2646
(402) 484-0444
Mailing address
8101 O ST, SUITE 118, LINCOLN, NE 68510-2646
(402) 484-0444

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
834
NE

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
10025109200
NE
Enumeration date
02/02/2012
Last updated
05/13/2013
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