Provider Demographics
NPI:1487227955
Name:TUDER, SHELBY (PLMHP)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:
Last Name:TUDER
Suffix:
Gender:F
Credentials:PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6023 MERIDIAN DR APT 358
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68504-1064
Mailing Address - Country:US
Mailing Address - Phone:402-802-6538
Mailing Address - Fax:
Practice Address - Street 1:736 E MILITARY AVE
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-5183
Practice Address - Country:US
Practice Address - Phone:402-512-1884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-21
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE12697101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health