Provider Demographics
NPI:1417259425
Name:MCGILL, ELISSA RAE (LIMHP)
Entity Type:Individual
Prefix:MRS
First Name:ELISSA
Middle Name:RAE
Last Name:MCGILL
Suffix:
Gender:F
Credentials:LIMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5518 147TH ST
Mailing Address - Street 2:
Mailing Address - City:WEEPING WATER
Mailing Address - State:NE
Mailing Address - Zip Code:68463-2312
Mailing Address - Country:US
Mailing Address - Phone:402-709-3140
Mailing Address - Fax:
Practice Address - Street 1:830 L ST STE 100
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68508-2205
Practice Address - Country:US
Practice Address - Phone:402-709-3140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1765101YP2500X
NE719101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025930500Medicaid