Healthcare Provider Details

I. General information

NPI: 1750097069
Provider Name (Legal Business Name): MARIAH HINTZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2023
Last Update Date: 01/30/2023
Certification Date: 01/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 J ST STE 110
LINCOLN NE
68508-2967
US

IV. Provider business mailing address

610 J ST STE 110
LINCOLN NE
68508-2967
US

V. Phone/Fax

Practice location:
  • Phone: 402-937-8323
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number13294
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: