Provider Demographics
NPI:1891094975
Name:DESMOINEAUX, MARIE D (LIMHP, LMHP)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:D
Last Name:DESMOINEAUX
Suffix:
Gender:F
Credentials:LIMHP, LMHP
Other - Prefix:
Other - First Name:MARIE
Other - Middle Name:D
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4920 SOUTH 30TH STREET
Mailing Address - Street 2:SUITE 103
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68107-1656
Mailing Address - Country:US
Mailing Address - Phone:402-734-4110
Mailing Address - Fax:402-991-5642
Practice Address - Street 1:4920 SOUTH 30TH STREET
Practice Address - Street 2:SUITE 103
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68107-1656
Practice Address - Country:US
Practice Address - Phone:402-734-4110
Practice Address - Fax:402-991-5642
Is Sole Proprietor?:No
Enumeration Date:2011-03-15
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1081101YM0800X
NE4192101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health