Provider Demographics
NPI:1629187737
Name:STUART, DEBRA K (MS)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:K
Last Name:STUART
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3617 POTOMAC LN
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-5478
Mailing Address - Country:US
Mailing Address - Phone:402-499-4002
Mailing Address - Fax:
Practice Address - Street 1:2900 S 70TH ST
Practice Address - Street 2:SUITE 150
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-3688
Practice Address - Country:US
Practice Address - Phone:402-486-1101
Practice Address - Fax:402-486-1614
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7374101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025012300Medicaid