Organization
CAMP-GRIMIT PETERSEN LLC
Active
Other names
Collaborative Psych Practitioners
Organization subpart
No
Provider details
NPI number
Authorized official
MOLLY PETERSEN APRN (CO-OWNER)
(402) 332-7648
Entity
Organization
Contact information
Practice address
12077 ELMWOOD DR, BENNINGTON, NE 68007-1716
(402) 332-7648
Mailing address
12077 ELMWOOD DR, BENNINGTON, NE 68007-1716
(402) 332-7648
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
110773
NE
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
111672
NE
Other
Enumeration date
04/12/2017
Last updated
04/12/2017
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