Provider Demographics
NPI:1184072027
Name:HERGOTT, MARIAH
Entity type:Individual
Prefix:
First Name:MARIAH
Middle Name:
Last Name:HERGOTT
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:MARIAH
Other - Middle Name:
Other - Last Name:RAMOLD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:110 N 37TH ST STE 405
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-3283
Mailing Address - Country:US
Mailing Address - Phone:402-230-7576
Mailing Address - Fax:
Practice Address - Street 1:802 CUSTER AVE STE B
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-0859
Practice Address - Country:US
Practice Address - Phone:402-230-7576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-01
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE10893101Y00000X
NE2273101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor