Basic Information
| Provider Information | |||||||||
| NPI: | 1811302722 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BURIVAL | ||||||||
| FirstName: | MATTHEW | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 246 | ||||||||
| Address2: | |||||||||
| City: | ONEILL | ||||||||
| State: | NE | ||||||||
| PostalCode: | 687630246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4023362800 | ||||||||
| FaxNumber: | 4023362849 | ||||||||
| Practice Location | |||||||||
| Address1: | 405 W DOUGLAS ST | ||||||||
| Address2: | |||||||||
| City: | ONEILL | ||||||||
| State: | NE | ||||||||
| PostalCode: | 687631719 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4023362800 | ||||||||
| FaxNumber: | 4023362849 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2014 | ||||||||
| LastUpdateDate: | 06/30/2014 | ||||||||
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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 | 104100000X | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.