Provider Demographics
NPI:1003590878
Name:TOLLY, MADELEINE HANNA (MS PLMHP)
Entity Type:Individual
Prefix:
First Name:MADELEINE
Middle Name:HANNA
Last Name:TOLLY
Suffix:
Gender:F
Credentials:MS PLMHP
Other - Prefix:
Other - First Name:MADDIE
Other - Middle Name:
Other - Last Name:TOLLY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1011 LEAVENWORTH ST # 2933
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68102-2933
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1011 LEAVENWORTH ST # 2933
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68102-2933
Practice Address - Country:US
Practice Address - Phone:402-614-4870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health