Provider Demographics
NPI:1609855998
Name:ZIEGENBEIN, MARK DOUGLAS (LMHP LMFT)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:DOUGLAS
Last Name:ZIEGENBEIN
Suffix:
Gender:M
Credentials:LMHP LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10824 OLD MILL RD
Mailing Address - Street 2:STE 21
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-2642
Mailing Address - Country:US
Mailing Address - Phone:402-330-6060
Mailing Address - Fax:402-330-6108
Practice Address - Street 1:10824 OLD MILL RD
Practice Address - Street 2:STE 21
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-2642
Practice Address - Country:US
Practice Address - Phone:402-330-6060
Practice Address - Fax:402-330-6108
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1110101YP2500X
NE036106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE84447OtherBLUE CROSS BLUE SHIELD
266613Medicare ID - Type Unspecified