Provider Demographics
NPI:1023380052
Name:LIANE BODE, LMHP, CPC
Entity Type:Organization
Organization Name:LIANE BODE, LMHP, CPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INDEPENDENT MENTAL HEALTH PRACTIT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LIANE
Authorized Official - Middle Name:L
Authorized Official - Last Name:BODE
Authorized Official - Suffix:
Authorized Official - Credentials:LIMHP
Authorized Official - Phone:402-844-3073
Mailing Address - Street 1:1309 N 9TH ST
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-0854
Mailing Address - Country:US
Mailing Address - Phone:402-844-3073
Mailing Address - Fax:
Practice Address - Street 1:1309 N 9TH ST
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-0854
Practice Address - Country:US
Practice Address - Phone:402-844-3073
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-07
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE833101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1700919347Medicaid