Basic Information
| Provider Information | |||||||||
| NPI: | 1982935045 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FLOYD | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | BURTON | ||||||||
| NamePrefix: | MR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2130 S 17TH ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | LINCOLN | ||||||||
| State: | NE | ||||||||
| PostalCode: | 685023750 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024760104 | ||||||||
| FaxNumber: | 4024382801 | ||||||||
| Practice Location | |||||||||
| Address1: | 2130 S 17TH ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | LINCOLN | ||||||||
| State: | NE | ||||||||
| PostalCode: | 685023750 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024760104 | ||||||||
| FaxNumber: | 4024382801 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/28/2010 | ||||||||
| LastUpdateDate: | 01/28/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 511 | NE | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YM0800X | 2368 | NE | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.