Provider Demographics
NPI:1538384417
Name:DORSEY, EVETTE (BA,MS,PLMHP)
Entity type:Individual
Prefix:
First Name:EVETTE
Middle Name:
Last Name:DORSEY
Suffix:
Gender:F
Credentials:BA,MS,PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:939 S 89TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-5105
Mailing Address - Country:US
Mailing Address - Phone:402-612-7066
Mailing Address - Fax:402-614-6832
Practice Address - Street 1:5620 AMES AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68104-2754
Practice Address - Country:US
Practice Address - Phone:402-612-7066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7888101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE100251158900Medicaid