Provider Demographics
NPI:1497815765
Name:ENGDAHL, MARY P (LMHP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:P
Last Name:ENGDAHL
Suffix:
Gender:F
Credentials:LMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 S 24TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68102-1202
Mailing Address - Country:US
Mailing Address - Phone:402-342-7007
Mailing Address - Fax:402-661-7117
Practice Address - Street 1:124 S 24TH ST STE 230
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68102-1226
Practice Address - Country:US
Practice Address - Phone:402-978-5656
Practice Address - Fax:402-591-5075
Is Sole Proprietor?:No
Enumeration Date:2006-12-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1166101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health