1912606856 NPI number — CSTHERAPY LLC

Table of content: (NPI 1912606856)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912606856 NPI number — CSTHERAPY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CSTHERAPY LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912606856
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/28/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8216 CITY CENTER DR APT 648
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LA VISTA
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68128-2954
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-427-4161
Provider Business Mailing Address Fax Number:
833-933-0633

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8031 W CENTER RD STE 204
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OMAHA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68124-3134
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
531-233-5007
Provider Business Practice Location Address Fax Number:
833-933-0633
Provider Enumeration Date:
02/28/2023

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SNYDER
Authorized Official First Name:
CARA
Authorized Official Middle Name:
Authorized Official Title or Position:
CLINICAL SOCIAL WORKER/ THERAPIST
Authorized Official Telephone Number:
402-427-4161

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1487014346 . This is a "INDIVIDUAL/ SOLO NPI 1" identifier . This identifiers is of the category "OTHER".