Healthcare Provider Details

I. General information

NPI: 1346408846
Provider Name (Legal Business Name): BRENDA J NUTT LADL PLMHP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2008
Last Update Date: 06/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2444 O STREET C/O CHILE GUIDANCE CENTER
LINCOLN NE
68510
US

IV. Provider business mailing address

2444 O STREET C/O CHILE GUIDANCE CENTER
LINCOLN NE
68510
US

V. Phone/Fax

Practice location:
  • Phone: 402-475-7666
  • Fax: 402-476-9623
Mailing address:
  • Phone: 402-475-7666
  • Fax: 402-476-9623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number591
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: