Healthcare Provider Details

I. General information

NPI: 1457285421
Provider Name (Legal Business Name): MARCELLO DE VELAZQUEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2844 SCHILLING PLZ
BELLEVUE NE
68123-3209
US

IV. Provider business mailing address

2844 SCHILLING PLZ
BELLEVUE NE
68123-3209
US

V. Phone/Fax

Practice location:
  • Phone: 402-708-9566
  • Fax: 402-708-9566
Mailing address:
  • Phone: 402-708-9566
  • Fax: 402-708-9566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number13200
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: