Provider Demographics
NPI:1467407361
Name:BACKHUUS, TROY A (LMHP)
Entity Type:Individual
Prefix:MR
First Name:TROY
Middle Name:A
Last Name:BACKHUUS
Suffix:
Gender:M
Credentials:LMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1311 S 9TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68108-3629
Mailing Address - Country:US
Mailing Address - Phone:402-449-2930
Mailing Address - Fax:
Practice Address - Street 1:1311 S 9TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68108-3629
Practice Address - Country:US
Practice Address - Phone:402-449-2930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3045101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE5-6-80-8716Medicaid