Provider Demographics
NPI:1568970259
Name:MISTY A GASA
Entity Type:Organization
Organization Name:MISTY A GASA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:MISTY
Authorized Official - Middle Name:A
Authorized Official - Last Name:GASA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW/LMHP
Authorized Official - Phone:402-515-5281
Mailing Address - Street 1:7155 S 41ST TER
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68147-1056
Mailing Address - Country:US
Mailing Address - Phone:402-515-5281
Mailing Address - Fax:308-832-4958
Practice Address - Street 1:7155 S 41ST TER
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68147-1056
Practice Address - Country:US
Practice Address - Phone:402-515-5281
Practice Address - Fax:308-832-4958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-16
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026648100Medicaid