Basic Information
| Provider Information | |||||||||
| NPI: | 1386863728 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MEZZELL | ||||||||
| FirstName: | SYLVIA | ||||||||
| MiddleName: | LEN | ||||||||
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| Credential: | PLMHP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7907 CHINAWOOD AVE APT 8 | ||||||||
| Address2: | |||||||||
| City: | LAVISTA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681282867 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4023312784 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5115 F STREET | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681172807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4023979866 | ||||||||
| FaxNumber: | 4023971404 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/24/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 7953 | NE | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.