Provider Demographics
NPI:1033861695
Name:IRVINE, DARRELL DEAN (PMHP)
Entity Type:Individual
Prefix:
First Name:DARRELL
Middle Name:DEAN
Last Name:IRVINE
Suffix:
Gender:M
Credentials:PMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 460775
Mailing Address - Street 2:
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-0775
Mailing Address - Country:US
Mailing Address - Phone:402-730-3326
Mailing Address - Fax:
Practice Address - Street 1:13513 COTTNER ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-1629
Practice Address - Country:US
Practice Address - Phone:402-809-9465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-24
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE12873101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health