Provider Demographics
NPI:1235611054
Name:TOLLE, BRADY (PCMSW, PLMHP)
Entity Type:Individual
Prefix:
First Name:BRADY
Middle Name:
Last Name:TOLLE
Suffix:
Gender:M
Credentials:PCMSW, PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 CITY VIEW CT
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68521-4154
Mailing Address - Country:US
Mailing Address - Phone:402-641-4338
Mailing Address - Fax:
Practice Address - Street 1:2229 J ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-2933
Practice Address - Country:US
Practice Address - Phone:402-436-1301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-29
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE115971041C0700X
NE7271104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical