Provider Demographics
NPI:1891990644
Name:KWAST-LIPKER, MYRA JEANNE (LMHP)
Entity Type:Individual
Prefix:
First Name:MYRA
Middle Name:JEANNE
Last Name:KWAST-LIPKER
Suffix:
Gender:F
Credentials:LMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 E 10TH ST
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:NE
Mailing Address - Zip Code:68978-2305
Mailing Address - Country:US
Mailing Address - Phone:402-879-3647
Mailing Address - Fax:402-746-5684
Practice Address - Street 1:721 W 6TH AVE
Practice Address - Street 2:
Practice Address - City:RED CLOUD
Practice Address - State:NE
Practice Address - Zip Code:68970-2278
Practice Address - Country:US
Practice Address - Phone:402-746-5614
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE8145101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE8145OtherSTATE LISENSE