Individual
MAXINE NOTICE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA
Contact information
Practice address
139 S. 40TH ST, OMAHA, NE 68131-0001
(402) 595-3939
(402) 595-3898
Mailing address
988102 NEBRASKA MEDICAL CTR, OMAHA, NE 68198-8102
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
1161
NH
101YM0800X
Mental Health Counselor
Primary
1973
NE
Other
Enumeration date
03/10/2016
Last updated
10/16/2018
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