Provider Demographics
NPI:1407097033
Name:MIMICK, LORI L (LIMHP, LPC, LADC)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:L
Last Name:MIMICK
Suffix:
Gender:F
Credentials:LIMHP, LPC, LADC
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:L
Other - Last Name:MIMICK-CARDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LIMHP, LPC, LADC
Mailing Address - Street 1:5343 FRANCIS ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68504
Mailing Address - Country:US
Mailing Address - Phone:402-477-0651
Mailing Address - Fax:
Practice Address - Street 1:5343 FRANCIS ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68504
Practice Address - Country:US
Practice Address - Phone:402-890-7843
Practice Address - Fax:024-770-3324
Is Sole Proprietor?:No
Enumeration Date:2009-03-11
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE891101YA0400X
NE1369101YM0800X
NE3849101YM0800X
NE1909101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health