Basic Information
| Provider Information | |||||||||
| NPI: | 1447680764 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SAZAMA | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | CRAIG | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MSE, PLMHP, PLADC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 900 W NORFOLK AVE | ||||||||
| Address2: | STE 200 | ||||||||
| City: | NORFOLK | ||||||||
| State: | NE | ||||||||
| PostalCode: | 687015006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4023703140 | ||||||||
| FaxNumber: | 4023703373 | ||||||||
| Practice Location | |||||||||
| Address1: | 900 W NORFOLK AVE | ||||||||
| Address2: | STE 200 | ||||||||
| City: | NORFOLK | ||||||||
| State: | NE | ||||||||
| PostalCode: | 687015006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4023703140 | ||||||||
| FaxNumber: | 4023703373 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/22/2013 | ||||||||
| LastUpdateDate: | 11/13/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 10121 | NE | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.