Provider Demographics
NPI:1104832393
Name:MILLARD, LAURIE A (LIMHP, CPC)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:A
Last Name:MILLARD
Suffix:
Gender:F
Credentials:LIMHP, CPC
Other - Prefix:MS
Other - First Name:LAURIE
Other - Middle Name:A
Other - Last Name:BUCHHOLZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LIMHP, CPC
Mailing Address - Street 1:PO BOX 2315
Mailing Address - Street 2:200 NORTH 34TH ST
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68702-2315
Mailing Address - Country:US
Mailing Address - Phone:402-371-3044
Mailing Address - Fax:402-371-9643
Practice Address - Street 1:200 NORTH 34TH ST
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68702-2315
Practice Address - Country:US
Practice Address - Phone:402-371-3044
Practice Address - Fax:402-371-9643
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1001106H00000X
NE1599106H00000X
NE144101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47083165927Medicaid
NE47083165926Medicaid
NE84186OtherBCBS
NE84186OtherBCBS