Provider Demographics
NPI:1689685877
Name:PLACEK, DIXIE RUTHANN (MA, LIMHP, LIMFT)
Entity type:Individual
Prefix:MRS
First Name:DIXIE
Middle Name:RUTHANN
Last Name:PLACEK
Suffix:
Gender:F
Credentials:MA, LIMHP, LIMFT
Other - Prefix:MRS
Other - First Name:DIXIE
Other - Middle Name:RUTHANN
Other - Last Name:PLACEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LIMFT, LIMHP
Mailing Address - Street 1:422 SOUTH BOSWELL AVENUE
Mailing Address - Street 2:
Mailing Address - City:CRETE
Mailing Address - State:NE
Mailing Address - Zip Code:68333-3253
Mailing Address - Country:US
Mailing Address - Phone:402-826-2829
Mailing Address - Fax:402-826-2829
Practice Address - Street 1:422 SOUTH BOSWELL AVENUE
Practice Address - Street 2:
Practice Address - City:CRETE
Practice Address - State:NE
Practice Address - Zip Code:68333-3253
Practice Address - Country:US
Practice Address - Phone:402-826-2829
Practice Address - Fax:402-826-2829
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE601101YM0800X
NE341101YM0800X, 106H00000X
NE045106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025753600Medicaid
NE47077425426Medicaid
NE84265OtherBC/BS