Provider Demographics
NPI:1295092534
Name:CAZARES, MARYSOL (PLMHP, PLADC)
Entity type:Individual
Prefix:MRS
First Name:MARYSOL
Middle Name:
Last Name:CAZARES
Suffix:
Gender:F
Credentials:PLMHP, PLADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1244 MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:CRETE
Mailing Address - State:NE
Mailing Address - Zip Code:68333-2260
Mailing Address - Country:US
Mailing Address - Phone:402-937-0281
Mailing Address - Fax:
Practice Address - Street 1:1244 MAIN AVE
Practice Address - Street 2:
Practice Address - City:CRETE
Practice Address - State:NE
Practice Address - Zip Code:68333-2260
Practice Address - Country:US
Practice Address - Phone:402-937-0281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-11
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NEP-149712956101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1002728500Medicaid
NEP-149712956OtherPLADC, PLMHP