Provider Demographics
NPI:1760452213
Name:SVOBODA, DANIAL T (MS, LIMPH, LMHP, LAD)
Entity Type:Individual
Prefix:MR
First Name:DANIAL
Middle Name:T
Last Name:SVOBODA
Suffix:
Gender:M
Credentials:MS, LIMPH, LMHP, LAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4111 4TH AVENUE
Mailing Address - Street 2:SUITE 32
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68845-8323
Mailing Address - Country:US
Mailing Address - Phone:308-234-6029
Mailing Address - Fax:308-237-4792
Practice Address - Street 1:4111 4TH AVENUE
Practice Address - Street 2:SUITE 32
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845-8323
Practice Address - Country:US
Practice Address - Phone:308-234-6029
Practice Address - Fax:308-237-4792
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NELADC474101Y00000X
NELMHP2794101Y00000X
NELIMHP 13101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47077781326Medicaid
098125Medicare ID - Type Unspecified