Provider Demographics
NPI:1225699036
Name:RUGG, NICOLE (PLMHP)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:RUGG
Suffix:
Gender:F
Credentials:PLMHP
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:FREEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:4109 S 147TH PLZ APT 203
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-5509
Mailing Address - Country:US
Mailing Address - Phone:847-946-4376
Mailing Address - Fax:
Practice Address - Street 1:6681 SORENSEN PKWY
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68152-2139
Practice Address - Country:US
Practice Address - Phone:402-932-8884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-23
Last Update Date:2019-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11784101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor