1265601827 NPI number — MRS. LEANN MAXINE TICE L.MHP, LPC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265601827 NPI number — MRS. LEANN MAXINE TICE L.MHP, LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TICE
Provider First Name:
LEANN
Provider Middle Name:
MAXINE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
L.MHP, LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RASMUSSEN
Provider Other First Name:
LEANN
Provider Other Middle Name:
MAXINE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMHP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1265601827
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/08/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1919 S 40TH ST
Provider Second Line Business Mailing Address:
SUITE 212
Provider Business Mailing Address City Name:
LINCOLN
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68506-5243
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-441-9280
Provider Business Mailing Address Fax Number:
402-441-9279

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1919 S 40TH ST
Provider Second Line Business Practice Location Address:
SUITE 212
Provider Business Practice Location Address City Name:
LINCOLN
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68506-5243
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-441-9280
Provider Business Practice Location Address Fax Number:
402-441-9279
Provider Enumeration Date:
02/27/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  8555 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: 3704 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YP2500X , with the licence number: 1843 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 96079 . This is a "BLUECROSS & BLUE SHIELD" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 456304000 . This is a "MAGELLAN MANAGED CARE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 456304000 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 470756369-26 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 470774254-26 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com