55 Mdos
Organization Active NPI Clinical Psychologist · Offutt a F B, NE
NPI 1285624262 · NPPES record last updated Jun 13, 2008
Key facts
- NPI
- 1285624262
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- 679 (OK)
- Legal business name
- 55 MDOS
- Practice address
- 55 Mdos Sgo
2501 Capehart Rd
Offutt a F B, NE 68113-1712 - Phone
- (402) 294-7883
- NPI assigned
- Oct 21, 2005
- Organization subpart
- No
Authorized official
- Name
- Dr. Stephen F Hamilton, PHD
- Title
- Menal Health Flight Commander
- Phone
- (402) 294-7883
Practitioners 2
-
Kenneth Clark Komyathy, LCSW
-
Dale Richard Lush, LCSW
National Provider Directory
Locations
55 Mdos Sgo
Offutt AFB, NE 68113
Phone (402) 294-7411
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist |
103TC0700X | 679 | OK | Yes |
Addresses
Primary practice location
55 Mdos Sgo
2501 Capehart Rd
Offutt a F B, NE 68113-1712
Mailing address
55 Mdos Sgo
2501 Capehart Rd
Offutt a F B, NE 68113-1712
Phone (402) 294-7883
Other providers in Offutt a F B, NE
All providers in Offutt a F B, NE · Clinical Psychologist in Nebraska
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 13, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.