Healthcare Provider Details

I. General information

NPI: 1386707842
Provider Name (Legal Business Name): EDWIN PAUL MAUPIN MA LMHP LIMHP CPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 04/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 E 10TH ST
OGALLALA NE
69153-1442
US

IV. Provider business mailing address

PO BOX 297
OGALLALA NE
69153-0297
US

V. Phone/Fax

Practice location:
  • Phone: 308-284-6519
  • Fax: 308-284-6513
Mailing address:
  • Phone: 308-284-6519
  • Fax: 308-284-6513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number970
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1570
License Number StateNE
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1047
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: