Healthcare Provider Details

I. General information

NPI: 1508201047
Provider Name (Legal Business Name): MICHELLE BEDORE PLMHP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2013
Last Update Date: 05/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 GATEWAY MALL SUITE 342
LINCOLN NE
68505-2489
US

IV. Provider business mailing address

210 GATEWAY MALL SUITE 342
LINCOLN NE
68505-2489
US

V. Phone/Fax

Practice location:
  • Phone: 720-238-5469
  • Fax: 402-434-3970
Mailing address:
  • Phone: 720-238-5469
  • Fax: 402-434-3970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number9953
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: