Provider Demographics
NPI:1164561205
Name:NORDYKE KING, TIA MARIE (MA LMHP LPC)
Entity Type:Individual
Prefix:MRS
First Name:TIA
Middle Name:MARIE
Last Name:NORDYKE KING
Suffix:
Gender:F
Credentials:MA LMHP LPC
Other - Prefix:MRS
Other - First Name:TIA
Other - Middle Name:MARIE
Other - Last Name:NORDYKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:5630 S 84TH ST STE 104
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-4470
Mailing Address - Country:US
Mailing Address - Phone:402-309-3892
Mailing Address - Fax:
Practice Address - Street 1:5630 S 84TH ST STE 104
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-4470
Practice Address - Country:US
Practice Address - Phone:402-309-3892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1499101YM0800X
NE2338101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE233141OtherMIDLANDS CHOICE
NE48027OtherBCBS OF NEBRASKA
NE10025867800Medicaid