Provider Demographics
NPI:1063554210
Name:ARMSTRONG, MARK KETTER (MSW PLMHP)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:KETTER
Last Name:ARMSTRONG
Suffix:
Gender:M
Credentials:MSW PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11836 ARBOR STREET
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-2937
Mailing Address - Country:US
Mailing Address - Phone:402-898-8881
Mailing Address - Fax:402-898-8886
Practice Address - Street 1:11836 ARBOR STREET
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-2937
Practice Address - Country:US
Practice Address - Phone:402-898-8881
Practice Address - Fax:402-898-8886
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7834101YM0800X
CALCS22682LCSW1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical