Provider Demographics
NPI:1487259891
Name:TOSH, MICHAEL JON (LIMHP)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JON
Last Name:TOSH
Suffix:
Gender:M
Credentials:LIMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 N 248TH CIR
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:NE
Mailing Address - Zip Code:68069-4669
Mailing Address - Country:US
Mailing Address - Phone:402-578-7639
Mailing Address - Fax:
Practice Address - Street 1:10840 OLD MILL RD STE 300
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-2664
Practice Address - Country:US
Practice Address - Phone:402-578-7639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-02
Last Update Date:2023-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2312101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health