Provider Demographics
NPI:1548335482
Name:LUEBBERT, MICHAEL C (PHD)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:C
Last Name:LUEBBERT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11414 W CENTER RD
Mailing Address - Street 2:SUITE 243
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-4486
Mailing Address - Country:US
Mailing Address - Phone:402-333-8210
Mailing Address - Fax:402-333-2298
Practice Address - Street 1:11414 W CENTER RD
Practice Address - Street 2:SUITE 243
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-4486
Practice Address - Country:US
Practice Address - Phone:402-333-8210
Practice Address - Fax:402-333-2298
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE567103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE08164OtherBCBS OF NE
NE10025764500Medicaid
NENA1354Medicare PIN