Provider Demographics
NPI:1417719212
Name:HONOMICHL, MARK ALLAN (PLMHP)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ALLAN
Last Name:HONOMICHL
Suffix:
Gender:M
Credentials:PLMHP
Other - Prefix:
Other - First Name:MARK
Other - Middle Name:ALLAN
Other - Last Name:STANKEY
Other - Suffix:JR
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:222 E 29TH ST APT 1
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68847-3593
Mailing Address - Country:US
Mailing Address - Phone:308-830-2673
Mailing Address - Fax:
Practice Address - Street 1:2201 N BROADWELL AVE
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-2153
Practice Address - Country:US
Practice Address - Phone:308-832-3660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-26
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE13759101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health