Provider Demographics
NPI:1225213770
Name:POPE, MICHELLE J (LIMHP, LADC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:J
Last Name:POPE
Suffix:
Gender:F
Credentials:LIMHP, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9374 N ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68127-2307
Mailing Address - Country:US
Mailing Address - Phone:402-669-6204
Mailing Address - Fax:
Practice Address - Street 1:9374 N ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68127-2307
Practice Address - Country:US
Practice Address - Phone:402-669-7202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-03
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE992101YA0400X
NE871101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE871OtherSTATE OF NEBRASKA
NE992OtherSTATE OF NEBRASKA