Healthcare Provider Details

I. General information

NPI: 1659209799
Provider Name (Legal Business Name): TATE MAZOUR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7230 TALLGRASS PKWY APT 201J
LINCOLN NE
68521-6697
US

IV. Provider business mailing address

7230 TALLGRASS PKWY APT 201J
LINCOLN NE
68521-6697
US

V. Phone/Fax

Practice location:
  • Phone: 402-604-0331
  • Fax:
Mailing address:
  • Phone: 402-604-0331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: