Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 100674 | NE |
Y | 103T00000X | Psychologist | 100674 | NE |
N | 103TS0200X | School Psychologist | 100674 | NE |
NPI | 1043775885 |
---|---|
Provider Name | Dr. Paul Edward Menousek |
First Address | Gretna, NE 68028-4729 |
Second Address | Gretna, NE 68028-4729 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2019 |
Last Update Date | 06/02/2019 |