Healthcare Provider Details

I. General information

NPI: 1972701647
Provider Name (Legal Business Name): ADAM N. PROCTOR MC, NCC, LPC, LIMHP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2007
Last Update Date: 12/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5600 S 59TH ST SUITE 104
LINCOLN NE
68516-2386
US

IV. Provider business mailing address

5600 S 59TH ST SUITE 104
LINCOLN NE
68516-2386
US

V. Phone/Fax

Practice location:
  • Phone: 402-484-0595
  • Fax: 402-484-6306
Mailing address:
  • Phone: 402-484-0595
  • Fax: 402-484-6306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMHP-3150
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCPC-1670
License Number StateNE
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLIMHP-705
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: