Provider Demographics
NPI:1053465922
Name:RAINBOLT, ELLEN K (MS, LIMHP)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:K
Last Name:RAINBOLT
Suffix:
Gender:F
Credentials:MS, LIMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5114 LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-1247
Mailing Address - Country:US
Mailing Address - Phone:402-486-3010
Mailing Address - Fax:402-486-4205
Practice Address - Street 1:5114 LOCUST ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-1247
Practice Address - Country:US
Practice Address - Phone:402-486-3010
Practice Address - Fax:402-486-4205
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NELMHP 1427101YM0800X
NELIMHP 437101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1427OtherLMHP
NE437OtherLIMHP
NE82OtherCMFT
NE84984OtherBLUE CROSS BLUE SHIELD
NE345996000OtherMAGELLAN HEALTH
NE391913032-26Medicaid