1265589873 NPI number — JUDITH E. DEVRIES LMHP

Table of content: JUDITH E. DEVRIES LMHP (NPI 1265589873)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265589873 NPI number — JUDITH E. DEVRIES LMHP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEVRIES
Provider First Name:
JUDITH
Provider Middle Name:
E.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMHP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265589873
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/16/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
212 SOUTH 74TH STREET, SUITE 204
Provider Second Line Business Mailing Address:
212 SOUTH 74TH STREET, SUITE 204
Provider Business Mailing Address City Name:
OMAHA
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68114
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-932-5839
Provider Business Mailing Address Fax Number:
402-934-8344

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
212 SOUTH 74TH STREET, SUITE 204
Provider Second Line Business Practice Location Address:
212 SOUTH 74TH STREET, SUITE 204
Provider Business Practice Location Address City Name:
OMAHA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68114
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-932-5839
Provider Business Practice Location Address Fax Number:
402-934-8355
Provider Enumeration Date:
01/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X , with the licence number:  1452 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YM0800X , with the licence number: 1452 LMHP, 924 CPC , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: MIS # 345988000 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".




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