Provider Demographics
NPI:1700076148
Name:WALTEMATH, TODD (LADC, LMHP, LIMHP)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:
Last Name:WALTEMATH
Suffix:
Gender:M
Credentials:LADC, LMHP, LIMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2209 I ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68107-1921
Mailing Address - Country:US
Mailing Address - Phone:402-208-1804
Mailing Address - Fax:402-991-7581
Practice Address - Street 1:2209 I ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68107-1921
Practice Address - Country:US
Practice Address - Phone:402-208-1804
Practice Address - Fax:402-991-7581
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-01
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE333101YA0400X
NE3047101YM0800X
NE1187101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE730531000OtherMAGELLEN
NE10025385600Medicaid
NE10025423300Medicaid