Provider Demographics
NPI:1508303827
Name:BUNDY, NICHOLAS (MS, PLMHP, PLADC)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:BUNDY
Suffix:
Gender:M
Credentials:MS, PLMHP, PLADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 LEAVENWORTH ST # 2933
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68102-2933
Mailing Address - Country:US
Mailing Address - Phone:402-614-4870
Mailing Address - Fax:
Practice Address - Street 1:1011 LEAVENWORTH ST # 2933
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68102-2933
Practice Address - Country:US
Practice Address - Phone:402-614-4870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-24
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
NE12760101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No104100000XBehavioral Health & Social Service ProvidersSocial Worker