Basic Information
| Provider Information | |||||||||
| NPI: | 1780676825 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MAXWELL | ||||||||
| FirstName: | BARBARA | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1939 S 62ND ST | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681062138 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4026165975 | ||||||||
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| Practice Location | |||||||||
| Address1: | 19696 OLD LINCOLN HWY | ||||||||
| Address2: | |||||||||
| City: | COUNCIL BLUFFS | ||||||||
| State: | IA | ||||||||
| PostalCode: | 515030301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7123251331 | ||||||||
| FaxNumber: | 7123251345 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 1863 | NE | X | Behavioral Health & Social Service Providers | Social Worker | 1041C0700X | 06318 | IA | X | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.