Provider Demographics
NPI:1447680764
Name:SAZAMA, MATTHEW CRAIG (MSE, PLMHP, PLADC)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:CRAIG
Last Name:SAZAMA
Suffix:
Gender:M
Credentials:MSE, PLMHP, PLADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 W NORFOLK AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-5006
Mailing Address - Country:US
Mailing Address - Phone:402-370-3140
Mailing Address - Fax:402-370-3373
Practice Address - Street 1:900 W NORFOLK AVE
Practice Address - Street 2:STE 200
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-5006
Practice Address - Country:US
Practice Address - Phone:402-370-3140
Practice Address - Fax:402-370-3373
Is Sole Proprietor?:No
Enumeration Date:2013-11-22
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE10121101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health