Provider Demographics
NPI:1174104368
Name:M. B. PSYCHOLOGICAL SERVICES, LLC
Entity type:Organization
Organization Name:M. B. PSYCHOLOGICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:BASNETT
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:308-627-3364
Mailing Address - Street 1:5539 S 27TH ST STE 104
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68512-1600
Mailing Address - Country:US
Mailing Address - Phone:402-261-8313
Mailing Address - Fax:402-939-0437
Practice Address - Street 1:5539 S 27TH ST STE 104
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68512-1600
Practice Address - Country:US
Practice Address - Phone:402-261-8313
Practice Address - Fax:402-939-0437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-19
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty