Provider Demographics
NPI:1033268313
Name:KEWIN, IRIS G (LMHP NCC)
Entity Type:Individual
Prefix:MRS
First Name:IRIS
Middle Name:G
Last Name:KEWIN
Suffix:
Gender:F
Credentials:LMHP NCC
Other - Prefix:MS
Other - First Name:IRIS
Other - Middle Name:G
Other - Last Name:RAMIREZ-HAGOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHP NCC
Mailing Address - Street 1:12619 BURT ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-4015
Mailing Address - Country:US
Mailing Address - Phone:402-980-4452
Mailing Address - Fax:402-614-1814
Practice Address - Street 1:12619 BURT ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-4015
Practice Address - Country:US
Practice Address - Phone:402-980-4452
Practice Address - Fax:402-614-1814
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3343101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE470608468-26Medicaid