Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | LADC 824 | NE |
N | 101YM0800X | Mental Health Counselor | LIMHP 473 | NE |
NPI | 1003012139 |
---|---|
Provider Name | Monica L Blizek |
First Address | Omaha, NE 68152-1929 |
Second Address | Omaha, NE 68152-1929 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2007 |
Last Update Date | 26/08/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
348833000 | MAGELLAN MANAGED CARE (01) | NE |
82146 | BLUE CROSS BLUE SHIELD (01) | NE |