NPIMap

Organization Active NPI

Fallbrook Behavioral Health, PC

  • Counseling Psychologist
  • Lincoln, NE
National Provider Identifier
1750654166
Registry record updated Feb 15, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Counseling PsychologistTaxonomy code 103TC1900X
License
747 Issued in NE
Legal business name
FALLBROOK BEHAVIORAL HEALTH, PC
Practice address
755 Fallbrook Blvd
Ste 100
Lincoln, NE 68521-4637
Phone
(402) 875-0632
Fax
(402) 438-2107
NPI assigned
Feb 15, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 15, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Thomas J Tiegs, PHDNPI 1447579313
Title
President
Phone
(402) 875-0632

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Counseling PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TC1900X 747 NE Primary

Addresses

Primary practice location

755 Fallbrook Blvd
Ste 100
Lincoln, NE 68521-4637

Mailing address

755 Fallbrook Blvd
Ste 100
Lincoln, NE 68521-4637
Phone (402) 875-0632

Other identifiers 1

IdentifierTypeStateIssuer
10025914900MedicaidNE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120404000453 NE Part B Supplier - Clinic/Group Practice 2466612106 Receives reassigned benefits from 1 practitioner
Practice locations: Lincoln, NE

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1329264000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1329264000000",
    "number": "1750654166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "755 FALLBROOK BLVD",
            "address_2": "STE 100",
            "city": "LINCOLN",
            "state": "NE",
            "postal_code": "685214637",
            "telephone_number": "402-875-0632",
            "fax_number": "402-438-2107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "755 FALLBROOK BLVD",
            "address_2": "STE 100",
            "city": "LINCOLN",
            "state": "NE",
            "postal_code": "685214637",
            "telephone_number": "402-875-0632",
            "fax_number": "402-438-2107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FALLBROOK BEHAVIORAL HEALTH, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-15",
        "last_updated": "2012-02-15",
        "status": "A",
        "authorized_official_last_name": "TIEGS",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "402-875-0632",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103TC1900X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Counseling",
            "state": "NE",
            "license": "747",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10025914900",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lincoln, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.