Provider Demographics
NPI:1871740753
Name:DVORAK, DAWSON E (MA, LMHP)
Entity type:Individual
Prefix:
First Name:DAWSON
Middle Name:E
Last Name:DVORAK
Suffix:
Gender:M
Credentials:MA, LMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5217 S. 28TH STREET
Mailing Address - Street 2:STEPHEN CENTER HERO PROGRAM
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68107
Mailing Address - Country:US
Mailing Address - Phone:402-715-5449
Mailing Address - Fax:402-715-5452
Practice Address - Street 1:5217 S. 28TH STREET
Practice Address - Street 2:STEPHEN CENTER HERO PROGRAM
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68107
Practice Address - Country:US
Practice Address - Phone:402-715-5449
Practice Address - Fax:402-715-5452
Is Sole Proprietor?:No
Enumeration Date:2008-08-22
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE8656101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE96065OtherBCBS
NE96065OtherBCBS