Provider Demographics
NPI:1447644455
Name:TR HEPBURN INC
Entity type:Organization
Organization Name:TR HEPBURN INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/CO OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:FREDERICK
Authorized Official - Last Name:HEPBURN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-474-2121
Mailing Address - Street 1:2039 Q ST
Mailing Address - Street 2:APT 101
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68503-3643
Mailing Address - Country:US
Mailing Address - Phone:402-474-2121
Mailing Address - Fax:402-477-9752
Practice Address - Street 1:2039 Q ST
Practice Address - Street 2:#101
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68503-3643
Practice Address - Country:US
Practice Address - Phone:402-474-2121
Practice Address - Fax:402-477-9752
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TR HEPBURN INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-03-27
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 101YM0800X, 363LP0808X
NE103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty