| Doctor Name: | MR. ERIC S THOMALLA |
| NPI Number: | 1174696314 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LADC805 |
| License Number: | |
| Business Practice Address: | 543 N Linden St Blue Valley Behavioral Health Wahoo, NE - 680661960 |
| Business Phone Number: | 4024434414 |
| Business Fax Number: | 4024433462 |
| Mailing Address: | 543 N Linden St, Blue Valley Behavioral Health WAHOO |
| State: | NE |
| Postal Code: | 680661960 |
| Phone Number: | 4024434414 |
| Fax Number: | 4024433462 |
| NPI Enumeration Date: | 11/16/2006 |
| NPI Last Update Date: | 08/06/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NE |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |