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General NPI Number Information
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NPI Number | 1245172790
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Entity Type | Individual
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Provider Name | DEV MEHTA
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Gender | Male
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Dates
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Enumeration Date | 04/06/2026
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Last Update Date | 04/06/2026
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Provider Practice Location Address
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Address Line | 12110 PORT GRACE BLVD
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City | LA VISTA
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State | NE
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Zip | 68128-3190
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Country | US
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Telephone | 402-645-0038
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Fax | 402-925-3936
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Provider Business Mailing Address
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Address Line | 12110 PORT GRACE BLVD STE 101
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City | LA VISTA
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State | NE
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Zip | 68128-3190
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Country | US
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Telephone | 402-645-1331
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 14823
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License Number State | NE
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