Provider Demographics
NPI:1699042531
Name:FIALA, MARIE KATHRYN (PLMHP)
Entity Type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:KATHRYN
Last Name:FIALA
Suffix:
Gender:F
Credentials:PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 SHERIDAN BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-6100
Mailing Address - Country:US
Mailing Address - Phone:402-489-1834
Mailing Address - Fax:402-489-2046
Practice Address - Street 1:3700 SHERIDAN BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-6100
Practice Address - Country:US
Practice Address - Phone:402-489-1834
Practice Address - Fax:402-489-2046
Is Sole Proprietor?:No
Enumeration Date:2011-11-21
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS8115104100000X
NE10018101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker