Healthcare Provider Details

I. General information

NPI: 1447114145
Provider Name (Legal Business Name): PAVEL DONGMO META
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1540 S FOLSOM ST APT 8
LINCOLN NE
68522-1688
US

IV. Provider business mailing address

1540 S FOLSOM ST APT 8
LINCOLN NE
68522-1688
US

V. Phone/Fax

Practice location:
  • Phone: 402-601-7725
  • Fax:
Mailing address:
  • Phone: 402-601-7725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberH14391699
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: