Provider Demographics
NPI:1861694879
Name:CZYZ, BENJAMIN (LIMHP)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:CZYZ
Suffix:
Gender:M
Credentials:LIMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9140 W DODGE RD STE 414
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-3317
Mailing Address - Country:US
Mailing Address - Phone:402-990-4918
Mailing Address - Fax:531-466-1335
Practice Address - Street 1:9140 W DODGE RD STE 414
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-3317
Practice Address - Country:US
Practice Address - Phone:402-990-4918
Practice Address - Fax:531-466-1335
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3171101YM0800X
NE104101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health