Basic Information
| Provider Information | |||||||||
| NPI: | 1922191469 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LARSEN | ||||||||
| FirstName: | NICOLE | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | M.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2200 ST MARY'S AVE | ||||||||
| Address2: | |||||||||
| City: | LINCOLN | ||||||||
| State: | NE | ||||||||
| PostalCode: | 685023749 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024416644 | ||||||||
| FaxNumber: | 4024418625 | ||||||||
| Practice Location | |||||||||
| Address1: | 2200 ST MARY'S AVE | ||||||||
| Address2: | |||||||||
| City: | LINCOLN | ||||||||
| State: | NE | ||||||||
| PostalCode: | 685023749 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024416644 | ||||||||
| FaxNumber: | 4024418625 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 2989 | NE | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.