Provider Demographics
NPI:1689792996
Name:MASEK, MARY L (MS, LMHP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:L
Last Name:MASEK
Suffix:
Gender:F
Credentials:MS, LMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11414 W CENTER RD
Mailing Address - Street 2:SUITE 233
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-4486
Mailing Address - Country:US
Mailing Address - Phone:402-502-5030
Mailing Address - Fax:402-502-9538
Practice Address - Street 1:11414 W CENTER RD
Practice Address - Street 2:SUITE 233
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-4486
Practice Address - Country:US
Practice Address - Phone:402-502-5030
Practice Address - Fax:402-502-9538
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7444101Y00000X
NE3502101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE7444OtherPLMHP LICENSE
NE3502OtherLMHP