Provider Demographics
NPI:1497949291
Name:BELL, ANTOINETTE LYNN
Entity Type:Individual
Prefix:MS
First Name:ANTOINETTE
Middle Name:LYNN
Last Name:BELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5620 AMES AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68104-2754
Mailing Address - Country:US
Mailing Address - Phone:402-453-5388
Mailing Address - Fax:
Practice Address - Street 1:1850 N 115TH PLZ APT 3505
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-4637
Practice Address - Country:US
Practice Address - Phone:402-871-6481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-05
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7977101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE7977Medicaid