Provider Demographics
NPI:1154462778
Name:KEADY, MICHAEL G (MS, LMHP)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:G
Last Name:KEADY
Suffix:
Gender:M
Credentials:MS, LMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 J ST
Mailing Address - Street 2:SUITE 320
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68508-2967
Mailing Address - Country:US
Mailing Address - Phone:402-435-1313
Mailing Address - Fax:402-435-5056
Practice Address - Street 1:610 J ST
Practice Address - Street 2:SUITE 320
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68508-2967
Practice Address - Country:US
Practice Address - Phone:402-435-1313
Practice Address - Fax:402-435-5056
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1140101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47074145326Medicaid