Provider Demographics
NPI:1801130323
Name:CURTIS, LILIAN (LICSW)
Entity type:Individual
Prefix:MRS
First Name:LILIAN
Middle Name:
Last Name:CURTIS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:LILIAN
Other - Middle Name:
Other - Last Name:CHANSA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4611 S 96TH ST STE 225
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68127-1243
Mailing Address - Country:US
Mailing Address - Phone:402-578-1255
Mailing Address - Fax:402-238-1707
Practice Address - Street 1:4611 S 96TH ST STE 225
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68127
Practice Address - Country:US
Practice Address - Phone:402-578-1255
Practice Address - Fax:402-238-1707
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-21
Last Update Date:2019-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE16201041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1541OtherINDEPENDENT MENTAL HEALTH PROVIDER LICENSE