Provider Demographics
NPI:1346408846
Name:NUTT, BRENDA J (LADL PLMHP)
Entity Type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:J
Last Name:NUTT
Suffix:
Gender:F
Credentials:LADL PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2444 O STREET
Mailing Address - Street 2:C/O CHILE GUIDANCE CENTER
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510
Mailing Address - Country:US
Mailing Address - Phone:402-475-7666
Mailing Address - Fax:402-476-9623
Practice Address - Street 1:2444 O STREET
Practice Address - Street 2:C/O CHILE GUIDANCE CENTER
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510
Practice Address - Country:US
Practice Address - Phone:402-475-7666
Practice Address - Fax:402-476-9623
Is Sole Proprietor?:No
Enumeration Date:2008-05-30
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE591101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE96118OtherBCBS
NE96118OtherBCBS