Healthcare Provider Details

I. General information

NPI: 1699956334
Provider Name (Legal Business Name): LEESA LARAINE DZURIS LMHP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2007
Last Update Date: 11/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 CHICAGO AVE SUITE #2
PLATTSMOUTH NE
68048-1833
US

IV. Provider business mailing address

PO BOX 34367
OMAHA NE
68134-0367
US

V. Phone/Fax

Practice location:
  • Phone: 402-296-4664
  • Fax: 402-296-4664
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2843
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: