Provider Demographics
NPI:1134328008
Name:MERIDETH, BRENDA KAYE (LIMHP, MSW)
Entity Type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:KAYE
Last Name:MERIDETH
Suffix:
Gender:F
Credentials:LIMHP, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 N 27TH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68503-1803
Mailing Address - Country:US
Mailing Address - Phone:402-476-1455
Mailing Address - Fax:402-476-1670
Practice Address - Street 1:2301 O ST
Practice Address - Street 2:STE 2
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-1124
Practice Address - Country:US
Practice Address - Phone:402-441-6642
Practice Address - Fax:402-476-1670
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-12
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEP-600101YA0400X
NE2939101YM0800X
NE1176104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEP-600OtherPLADC
NE1176OtherMSW
NE2939OtherLMHP