Provider Demographics
NPI:1326107723
Name:PATITZ, BEVERLY JEAN (PHD, LIMHP, LADC CPC)
Entity Type:Individual
Prefix:DR
First Name:BEVERLY
Middle Name:JEAN
Last Name:PATITZ
Suffix:
Gender:F
Credentials:PHD, LIMHP, LADC CPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 EAST 14TH,
Mailing Address - Street 2:SUITE 220
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901
Mailing Address - Country:US
Mailing Address - Phone:402-519-0159
Mailing Address - Fax:
Practice Address - Street 1:223 EAST 14TH,
Practice Address - Street 2:SUITE 220
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901
Practice Address - Country:US
Practice Address - Phone:402-519-0159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
688101YA0400X
NE945101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE588458000OtherMAGELLAN MIS NUMBER
NE10025039900Medicaid