Provider Demographics
NPI:1194800979
Name:VARGAS, HENRIETTA ANN (PHD)
Entity type:Individual
Prefix:MRS
First Name:HENRIETTA
Middle Name:ANN
Last Name:VARGAS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 17
Mailing Address - Street 2:
Mailing Address - City:SPRAGUE
Mailing Address - State:NE
Mailing Address - Zip Code:68438-0017
Mailing Address - Country:US
Mailing Address - Phone:402-434-8164
Mailing Address - Fax:402-434-8169
Practice Address - Street 1:7111 A STREET
Practice Address - Street 2:SUITE 101
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510
Practice Address - Country:US
Practice Address - Phone:402-434-8164
Practice Address - Fax:402-434-8169
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE104 210Medicaid