Provider Demographics
NPI:1184787053
Name:MAI, ANASTASIA ELIZABETH (MS, LIMHP)
Entity type:Individual
Prefix:MS
First Name:ANASTASIA
Middle Name:ELIZABETH
Last Name:MAI
Suffix:
Gender:F
Credentials:MS, LIMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2626 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69361-1608
Mailing Address - Country:US
Mailing Address - Phone:308-633-2845
Mailing Address - Fax:308-633-2847
Practice Address - Street 1:2626 BROADWAY
Practice Address - Street 2:
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-1608
Practice Address - Country:US
Practice Address - Phone:308-633-2845
Practice Address - Fax:308-633-2847
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2268101Y00000X
NE1263101YP2500X
NE1259101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional