Provider Demographics
NPI:1245370709
Name:RIES, PAUL D (MSW)
Entity type:Individual
Prefix:MISS
First Name:PAUL
Middle Name:D
Last Name:RIES
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 S 70TH ST
Mailing Address - Street 2:STE 150
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-3688
Mailing Address - Country:US
Mailing Address - Phone:402-486-1101
Mailing Address - Fax:402-486-1614
Practice Address - Street 1:2900 S 70TH ST
Practice Address - Street 2:STE 150
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-3688
Practice Address - Country:US
Practice Address - Phone:402-486-1101
Practice Address - Fax:402-486-1614
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1930101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025405900Medicare ID - Type Unspecified