Provider Demographics
NPI:1083754956
Name:PATTON, LAURIE NYSTROM (MS LIMHP LPC)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:NYSTROM
Last Name:PATTON
Suffix:
Gender:F
Credentials:MS LIMHP LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 S 40TH ST
Mailing Address - Street 2:SUITE 312
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-5243
Mailing Address - Country:US
Mailing Address - Phone:402-475-5069
Mailing Address - Fax:402-475-2350
Practice Address - Street 1:1919 S 40TH ST
Practice Address - Street 2:SUITE 312
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-5243
Practice Address - Country:US
Practice Address - Phone:402-475-5069
Practice Address - Fax:402-475-2350
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1053101YM0800X
NE333101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025820300Medicaid