Healthcare Provider Details

I. General information

NPI: 1265201453
Provider Name (Legal Business Name): HEATHER IRVIN MS,CSW,PMHP,PMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2023
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 GALVIN RD N
BELLEVUE NE
68005-4898
US

IV. Provider business mailing address

207 GALVIN RD N
BELLEVUE NE
68005-4898
US

V. Phone/Fax

Practice location:
  • Phone: 402-940-7387
  • Fax: 402-702-0538
Mailing address:
  • Phone: 402-940-7387
  • Fax: 402-702-0538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number13733
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number131765
License Number StateIA
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number7964
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: