Provider Demographics
NPI:1750174744
Name:AYIVI GUEDEHOUSSOU, AYITEH D
Entity type:Individual
Prefix:
First Name:AYITEH
Middle Name:D
Last Name:AYIVI GUEDEHOUSSOU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 EDGEWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-6024
Mailing Address - Country:US
Mailing Address - Phone:402-881-0238
Mailing Address - Fax:
Practice Address - Street 1:4606 N 56TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68104-2270
Practice Address - Country:US
Practice Address - Phone:402-881-0238
Practice Address - Fax:402-933-3434
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-23
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty