Provider Demographics
NPI:1295934230
Name:WICHELT, MARY BETH (PLADC)
Entity type:Individual
Prefix:
First Name:MARY BETH
Middle Name:
Last Name:WICHELT
Suffix:
Gender:F
Credentials:PLADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16005 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:BENNINGTON
Mailing Address - State:NE
Mailing Address - Zip Code:68007
Mailing Address - Country:US
Mailing Address - Phone:402-880-7949
Mailing Address - Fax:
Practice Address - Street 1:2101 S 42ND ST
Practice Address - Street 2:HEARTLAND FAMILY SERVICE
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68105
Practice Address - Country:US
Practice Address - Phone:402-553-3000
Practice Address - Fax:402-552-7444
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEP350101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)