Provider Demographics
NPI:1508201047
Name:BEDORE, MICHELLE (PLMHP)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:
Last Name:BEDORE
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 1:210 GATEWAY MALL
Mailing Address - Street 2:SUITE 342
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68505-2489
Mailing Address - Country:US
Mailing Address - Phone:720-238-5469
Mailing Address - Fax:402-434-3970
Practice Address - Street 1:210 GATEWAY MALL
Practice Address - Street 2:SUITE 342
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68505-2489
Practice Address - Country:US
Practice Address - Phone:720-238-5469
Practice Address - Fax:402-434-3970
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-09
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE9953101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health