Provider Demographics
NPI:1316232085
Name:TURNER BEARDSLEE, NICOLE J (LIMHP LADC)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:J
Last Name:TURNER BEARDSLEE
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 1:110 N 37TH ST STE 301
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-3283
Mailing Address - Country:US
Mailing Address - Phone:402-250-7925
Mailing Address - Fax:888-861-8730
Practice Address - Street 1:110 N 37TH ST STE 301
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-3283
Practice Address - Country:US
Practice Address - Phone:402-250-9725
Practice Address - Fax:888-618-7308
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-10
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE9326101Y00000X, 101YM0800X
NEP-976101YA0400X, 101Y00000X
NE2207101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47084203426Medicaid