MEDICARE: MS. LEESA LARAINE DZURIS LMHP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	2843	NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2843	OTHER	NE	LICENSE

General Provider Information

NPI Number	:	1699956334
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LEESA LARAINE DZURIS LMHP

Provider Business Mailing Address
First Line	:	PO BOX 34367
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68134-0367
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	316 CHICAGO AVE
Second Line	:	SUITE #2
City	:	PLATTSMOUTH
State	:	NE
Zip	:	68048-1833
Country	:	US
Telephone Number	:	402-296-4664
Fax Number	:	402-296-4664

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/23/2007
Last Update Date	:	11/23/2007

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