Provider Demographics
NPI:1063564383
Name:REZNICEK, LAWRENCE JAMES (MA)
Entity type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:JAMES
Last Name:REZNICEK
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 J ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68508-2900
Mailing Address - Country:US
Mailing Address - Phone:402-742-6273
Mailing Address - Fax:
Practice Address - Street 1:650 J ST
Practice Address - Street 2:SUITE 201
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68508-2900
Practice Address - Country:US
Practice Address - Phone:402-742-6273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE569101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025162000Medicaid