Provider Demographics
NPI:1144390642
Name:MICHELS, STACEY DAWN (LMHP, LIMHP, PLADC)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:DAWN
Last Name:MICHELS
Suffix:
Gender:F
Credentials:LMHP, LIMHP, PLADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:942 N 13TH ST
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:NE
Mailing Address - Zip Code:68361-0000
Mailing Address - Country:US
Mailing Address - Phone:402-759-3802
Mailing Address - Fax:402-759-3803
Practice Address - Street 1:942 N 13TH ST
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:NE
Practice Address - Zip Code:68361-0000
Practice Address - Country:US
Practice Address - Phone:402-759-3802
Practice Address - Fax:402-759-3803
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2009-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEP-838101YA0400X
NE626101Y00000X
NE2802101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025618500Medicaid
NE47084125026Medicaid