Provider Demographics
NPI:1871834028
Name:PANNING, SCOTT I (MA, PLMHP)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:I
Last Name:PANNING
Suffix:
Gender:M
Credentials:MA, PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13906 GOLD CIR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-2335
Mailing Address - Country:US
Mailing Address - Phone:402-932-6500
Mailing Address - Fax:
Practice Address - Street 1:13906 GOLD CIR
Practice Address - Street 2:SUITE 202
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-2335
Practice Address - Country:US
Practice Address - Phone:402-932-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-13
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE10478101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health