Provider Demographics
NPI:1194267740
Name:DRIVER, ANNIE KATE (PMSW, PLMHP)
Entity type:Individual
Prefix:
First Name:ANNIE
Middle Name:KATE
Last Name:DRIVER
Suffix:
Gender:F
Credentials:PMSW, PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4939 S 118TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-2213
Mailing Address - Country:US
Mailing Address - Phone:402-451-0787
Mailing Address - Fax:402-898-7750
Practice Address - Street 1:3549 FONTENELLE BLVD
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68104-3601
Practice Address - Country:US
Practice Address - Phone:402-451-0787
Practice Address - Fax:402-898-7750
Is Sole Proprietor?:No
Enumeration Date:2016-11-14
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11041101YM0800X
NE7117104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker