Provider Demographics
NPI:1376760389
Name:BARDSLEY, ADRIENNE THERESE (MS, PLMHP)
Entity Type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:THERESE
Last Name:BARDSLEY
Suffix:
Gender:F
Credentials:MS, PLMHP
Other - Prefix:
Other - First Name:ADRIENNE
Other - Middle Name:THERESE
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1030 SIMMS AVENUE
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503
Mailing Address - Country:US
Mailing Address - Phone:712-256-8550
Mailing Address - Fax:
Practice Address - Street 1:5115 F STREET
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68117
Practice Address - Country:US
Practice Address - Phone:402-397-9866
Practice Address - Fax:402-397-1404
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE8271101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health