Provider Demographics
NPI:1104937895
Name:MAXSON, THOMAS Z (LIMHP, LADC, MAC)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:Z
Last Name:MAXSON
Suffix:
Gender:M
Credentials:LIMHP, LADC, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4303 LOVELAND DR
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68845-2387
Mailing Address - Country:US
Mailing Address - Phone:308-233-0977
Mailing Address - Fax:308-237-9499
Practice Address - Street 1:2908 W 39TH ST STE B
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845-1245
Practice Address - Country:US
Practice Address - Phone:308-237-0391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE551101YA0400X
NE2326101YM0800X
NE667101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE470808292OtherMIDLANDS CHOICE
NE85196OtherBC/BS
NE470808292OtherTRICARE
NE728740000OtherMAGELLAN MIS
NE85196OtherBC/BS