Provider Demographics
NPI:1710059837
Name:VASCONCELLOS, ALLAN PAUL (PHD)
Entity Type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:PAUL
Last Name:VASCONCELLOS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1480 KAROL KAY BLVD
Mailing Address - Street 2:
Mailing Address - City:SEWARD
Mailing Address - State:NE
Mailing Address - Zip Code:68434-1197
Mailing Address - Country:US
Mailing Address - Phone:402-643-4095
Mailing Address - Fax:
Practice Address - Street 1:729 SEWARD STREET
Practice Address - Street 2:SUITE 2
Practice Address - City:SEWARD
Practice Address - State:NE
Practice Address - Zip Code:68434-2069
Practice Address - Country:US
Practice Address - Phone:402-643-3343
Practice Address - Fax:402-643-4048
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1116101YM0800X
NE40106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025208600Medicaid
NE470528515-02Medicaid
NE470528515-10Medicaid
NE470528515-06Medicaid
NE470528515-09Medicaid
NE470528515-00Medicaid
NE470528515-05Medicaid
NE470528515-03Medicaid
NE470528515-07Medicaid
84704OtherAUXILIARY
NE470528515-04Medicaid
NE470528515-13Medicaid
NE470528515-17Medicaid
NE470528515-01Medicaid
NE470528515-08Medicaid
NE470528515-14Medicaid
NE470528515-15Medicaid
84704OtherBCBS
NE470528515-01Medicaid