Provider Demographics
NPI:1700098647
Name:STREET, PATRICIA ANN (BA, MA, PHD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:ANN
Last Name:STREET
Suffix:
Gender:F
Credentials:BA, MA, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7911 DOUGAN DR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-3976
Mailing Address - Country:US
Mailing Address - Phone:402-434-8167
Mailing Address - Fax:
Practice Address - Street 1:7441 O ST
Practice Address - Street 2:SUITE 107
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-2468
Practice Address - Country:US
Practice Address - Phone:402-434-8167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE937101YM0800X
NE198101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47074070926Medicaid