Provider Demographics
NPI:1265299598
Name:STAGEMEYER, MICKY ALLAN (LIMHP)
Entity type:Individual
Prefix:MR
First Name:MICKY
Middle Name:ALLAN
Last Name:STAGEMEYER
Suffix:
Gender:M
Credentials:LIMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2802 30TH AVE
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68845-4035
Mailing Address - Country:US
Mailing Address - Phone:308-865-5313
Mailing Address - Fax:
Practice Address - Street 1:2802 30TH AVE
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845-4035
Practice Address - Country:US
Practice Address - Phone:308-865-5313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2093101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health