Provider Demographics
NPI:1225261662
Name:DEVRIES, INGRID REGINA (MA,PLMHP,PLADC)
Entity Type:Individual
Prefix:MS
First Name:INGRID
Middle Name:REGINA
Last Name:DEVRIES
Suffix:
Gender:F
Credentials:MA,PLMHP,PLADC
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 6582
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-0582
Mailing Address - Country:US
Mailing Address - Phone:402-435-2273
Mailing Address - Fax:
Practice Address - Street 1:1700 S 24TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68502-3003
Practice Address - Country:US
Practice Address - Phone:402-435-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-02
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEP817101YA0400X
NE8878101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)