Basic Information
| Provider Information | |||||||||
| NPI: | 1154371748 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CAPSTONE BEHAVIORAL HEALTH, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1941 S 42ND ST | ||||||||
| Address2: | STE. 328 | ||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681052939 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4026148444 | ||||||||
| FaxNumber: | 4026148443 | ||||||||
| Practice Location | |||||||||
| Address1: | 1941 S 42ND ST | ||||||||
| Address2: | STE. 328 | ||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681052939 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4026148444 | ||||||||
| FaxNumber: | 4026148443 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2006 | ||||||||
| LastUpdateDate: | 01/03/2014 | ||||||||
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| AuthorizedOfficialLastName: | CONNER | ||||||||
| AuthorizedOfficialFirstName: | NICOLE | ||||||||
| AuthorizedOfficialMiddleName: | RENEE | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR OF OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 4026148444 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.A., LMHP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 2587 | NE | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 10025317600 | 05 | NE | MEDICAID |