Provider Demographics
NPI:1891351995
Name:MARTINEZ EUSSE, MAURICIO (LMHP-PLC)
Entity Type:Individual
Prefix:
First Name:MAURICIO
Middle Name:
Last Name:MARTINEZ EUSSE
Suffix:
Gender:M
Credentials:LMHP-PLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1915 YORKSHIRE CT
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-1663
Mailing Address - Country:US
Mailing Address - Phone:402-217-0339
Mailing Address - Fax:
Practice Address - Street 1:1915 YORKSHIRE CT
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-1663
Practice Address - Country:US
Practice Address - Phone:402-217-0339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-14
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE5265101YM0800X
NE2499101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional