Provider Demographics
NPI:1457559890
Name:BURNHAM, BETH GERHARD (MA,,LMHP)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:GERHARD
Last Name:BURNHAM
Suffix:
Gender:F
Credentials:MA,,LMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 ROAD D
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NE
Mailing Address - Zip Code:68371-8886
Mailing Address - Country:US
Mailing Address - Phone:402-723-4308
Mailing Address - Fax:
Practice Address - Street 1:422 N HASTINGS AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-5107
Practice Address - Country:US
Practice Address - Phone:402-462-9400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2197LMHP AND1232-LPC101YM0800X
1232101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional