Provider Demographics
NPI:1326161118
Name:SEVERES, IAN M (LMHP, LADC)
Entity Type:Individual
Prefix:
First Name:IAN
Middle Name:M
Last Name:SEVERES
Suffix:
Gender:M
Credentials:LMHP, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8031 W CENTER RD
Mailing Address - Street 2:SUITE 324
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-3158
Mailing Address - Country:US
Mailing Address - Phone:402-502-5002
Mailing Address - Fax:402-502-5102
Practice Address - Street 1:8031 W CENTER RD
Practice Address - Street 2:SUITE 324
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-3158
Practice Address - Country:US
Practice Address - Phone:402-502-5002
Practice Address - Fax:402-502-5102
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3688101YM0800X
NE826101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)