Healthcare Provider Details

I. General information

NPI: 1467529040
Provider Name (Legal Business Name): JOSEPH KEITH HEYWOOD MC, MHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 S 16TH ST
LINCOLN NE
68502-3704
US

IV. Provider business mailing address

2950 N 49TH ST #3
LINCOLN NE
68504-2622
US

V. Phone/Fax

Practice location:
  • Phone: 801-481-5376
  • Fax:
Mailing address:
  • Phone: 402-817-4799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number8128
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: