Provider Demographics
NPI:1306041462
Name:BUGGS, DARNELL (PLMHP)
Entity Type:Individual
Prefix:MR
First Name:DARNELL
Middle Name:
Last Name:BUGGS
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 1:2724 N 24TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68110-2107
Mailing Address - Country:US
Mailing Address - Phone:402-491-3662
Mailing Address - Fax:402-491-3662
Practice Address - Street 1:15521 GRANT CIR
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68116-5136
Practice Address - Country:US
Practice Address - Phone:402-598-3662
Practice Address - Fax:402-491-3662
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7184101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47080196226Medicaid