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Individual

KEVIN EVERETT FITZMAURICE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.S.

Contact information

Practice address
3323 N 109TH PLZ, OMAHA, NE 68164-2908
(402) 573-7277
(402) 573-7360
Mailing address
3323 N 109TH PLZ, OMAHA, NE 68164-2908
(402) 573-7277
(402) 573-7360

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
00050
IA
101YM0800X
Mental Health Counselor
Primary
745
NE

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
00050
LICENSED MENTAL HEALTH
IA
05
10025178600
NE
01
33408
CCMHC
NE
01
745
MENTAL HEALTH PRACTITIONE
NE
01
800
CERTIFIED PROFESSIONAL CO
NE
Enumeration date
07/17/2006
Last updated
07/09/2007
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