Provider Demographics
NPI:1124271523
Name:MAUSBACH, KENNETH JAMES (MS)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:JAMES
Last Name:MAUSBACH
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 S 40TH ST
Mailing Address - Street 2:SUITE 212
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-5243
Mailing Address - Country:US
Mailing Address - Phone:402-441-9280
Mailing Address - Fax:402-441-9279
Practice Address - Street 1:1919 S 40TH ST
Practice Address - Street 2:SUITE 212
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-5243
Practice Address - Country:US
Practice Address - Phone:402-441-9280
Practice Address - Fax:402-441-9279
Is Sole Proprietor?:No
Enumeration Date:2008-10-29
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2498101YM0800X
NE10551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE456304000OtherMAGELLAN
NE47075636930Medicaid
NE10025734000Medicaid
NE47075636926Medicaid
NE249035OtherMIDLANDS INSURANCE
NE47075636998Medicaid
NE82144OtherNE BLUE CROSS & BLUE SHEILD
NE47075636926Medicaid