Provider Demographics
NPI:1245361260
Name:DORNER, CARL F III (PLMHP)
Entity type:Individual
Prefix:MR
First Name:CARL
Middle Name:F
Last Name:DORNER
Suffix:III
Gender:M
Credentials:PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23506 F ST # 5
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:NE
Mailing Address - Zip Code:68069-4209
Mailing Address - Country:US
Mailing Address - Phone:402-707-5589
Mailing Address - Fax:
Practice Address - Street 1:23506 F ST # 5
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:NE
Practice Address - Zip Code:68069-4209
Practice Address - Country:US
Practice Address - Phone:402-707-5589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7956101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025367000Medicaid