Provider Demographics
NPI:1033733761
Name:BERRY, MITCHELL (PLMHP)
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:
Last Name:BERRY
Suffix:
Gender:M
Credentials:PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13906 GOLD CIR STE 202
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-2336
Mailing Address - Country:US
Mailing Address - Phone:402-932-6500
Mailing Address - Fax:
Practice Address - Street 1:13906 GOLD CIR STE 202
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-2336
Practice Address - Country:US
Practice Address - Phone:402-932-6500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-28
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE12192101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health