Provider Demographics
NPI:1275600553
Name:LITTRELL, WAYNE (MS)
Entity Type:Individual
Prefix:MR
First Name:WAYNE
Middle Name:
Last Name:LITTRELL
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1706 BOYCE ST
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-4227
Mailing Address - Country:US
Mailing Address - Phone:402-462-4546
Mailing Address - Fax:
Practice Address - Street 1:215 S BURLINGTON AVE
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-5905
Practice Address - Country:US
Practice Address - Phone:402-463-6811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE171101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE252561OtherMIDLAND'S CHOICE
NE82560OtherBCBS PROVIDER NUMBER
NE10025460200Medicaid