Provider Demographics
NPI:1114928017
Name:DENTON, CAROLE LYNN (LIMHP)
Entity Type:Individual
Prefix:MRS
First Name:CAROLE
Middle Name:LYNN
Last Name:DENTON
Suffix:
Gender:F
Credentials:LIMHP
Other - Prefix:MRS
Other - First Name:CAROLE
Other - Middle Name:KROEGER
Other - Last Name:DENTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LIMHP
Mailing Address - Street 1:114 PONDEROSA DR
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-9646
Mailing Address - Country:US
Mailing Address - Phone:308-379-0806
Mailing Address - Fax:308-675-1021
Practice Address - Street 1:207 N PINE ST
Practice Address - Street 2:STE 106
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68801-5900
Practice Address - Country:US
Practice Address - Phone:308-382-8604
Practice Address - Fax:308-675-1021
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-02
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE404101YM0800X
NE288101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025856900Medicaid