Healthcare Provider Details

I. General information

NPI: 1275498354
Provider Name (Legal Business Name): DEAN IRVINE THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 CARRIAGE RD
PAPILLION NE
68046-2803
US

IV. Provider business mailing address

1101 CARRIAGE RD
PAPILLION NE
68046-2803
US

V. Phone/Fax

Practice location:
  • Phone: 402-730-3326
  • Fax:
Mailing address:
  • Phone: 402-730-3326
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. DARRELL DEAN IRVINE
Title or Position: CLINICAL MENTAL HEALTH THERAPIST
Credential: LIMHP
Phone: 402-730-3326