| Fallbrook Behavioral Health, Pc | |
|
755 Fallbrook Blvd Ste 100 Lincoln NE 68521-4637 | |
| (402) 875-0632 | |
| (402) 438-2107 |
| Full Name | Fallbrook Behavioral Health, Pc |
|---|---|
| Speciality | Psychologist |
| Location | 755 Fallbrook Blvd, Lincoln, Nebraska |
| Authorized Official Name and Position | Thomas J Tiegs (PRESIDENT) |
| Authorized Official Contact | 4028750632 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fallbrook Behavioral Health, Pc 755 Fallbrook Blvd Ste 100 Lincoln NE 68521-4637 Ph: (402) 875-0632 | Fallbrook Behavioral Health, Pc 755 Fallbrook Blvd Ste 100 Lincoln NE 68521-4637 Ph: (402) 875-0632 |
| NPI Number | 1750654166 |
|---|---|
| Provider Enumeration Date | 02/15/2012 |
| Last Update Date | 02/15/2012 |
| Medicare PECOS PAC ID | 2466612106 |
|---|---|
| Medicare Enrollment ID | O20120404000453 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750654166 | NPI | - | NPPES |
| 10025914900 | Medicaid | NE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC1900X | Psychologist - Counseling | 747 (Nebraska) | Primary |
| Provider Name | Thomas J Tiegs |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1447579313 PECOS PAC ID: 2264566124 Enrollment ID: I20100813000223 |
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