Provider Demographics
NPI:1033297064
Name:WOOD, MARY KAY (MSW)
Entity Type:Individual
Prefix:MISS
First Name:MARY
Middle Name:KAY
Last Name:WOOD
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 S 9TH ST
Mailing Address - Street 2:SUITE 15
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68508-2247
Mailing Address - Country:US
Mailing Address - Phone:402-477-8278
Mailing Address - Fax:402-477-8284
Practice Address - Street 1:315 S 9TH ST
Practice Address - Street 2:SUITE 15
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68508-2247
Practice Address - Country:US
Practice Address - Phone:402-477-8278
Practice Address - Fax:402-477-8284
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE761101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE5143OtherMIDLANDS CHOICE
NE82152OtherBLUE CROSS BLUE SHIELD OF
NE266379Medicare ID - Type Unspecified