Healthcare Provider Details

I. General information

NPI: 1487281150
Provider Name (Legal Business Name): NICOLE LOZANO PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2020
Last Update Date: 06/08/2021
Certification Date: 06/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8001 S 15TH ST STE C
LINCOLN NE
68512-9617
US

IV. Provider business mailing address

ASU STATION #10907
SAN ANGELO TX
76909-0907
US

V. Phone/Fax

Practice location:
  • Phone: 402-483-7900
  • Fax:
Mailing address:
  • Phone: 325-486-6116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number10657
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: