Provider Demographics
NPI:1770802464
Name:HOGAN, LIESEL (MS, PLMHP)
Entity type:Individual
Prefix:
First Name:LIESEL
Middle Name:
Last Name:HOGAN
Suffix:
Gender:F
Credentials:MS, PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 N SAINT JOSEPH AVE
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-7555
Mailing Address - Country:US
Mailing Address - Phone:402-463-5075
Mailing Address - Fax:402-463-5073
Practice Address - Street 1:225 N SAINT JOSEPH AVE
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-7555
Practice Address - Country:US
Practice Address - Phone:402-463-5075
Practice Address - Fax:402-463-5073
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-20
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE9141101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health