Provider Demographics
NPI:1629375100
Name:FRAZELL, CORAL ELIZABETH
Entity Type:Individual
Prefix:DR
First Name:CORAL
Middle Name:ELIZABETH
Last Name:FRAZELL
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:CORAL
Other - Middle Name:ELIZABETH
Other - Last Name:FRAZELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD, MA, LIMHP, LADC
Mailing Address - Street 1:4545 DODGE ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68132-3251
Mailing Address - Country:US
Mailing Address - Phone:402-553-2721
Mailing Address - Fax:
Practice Address - Street 1:4545 DODGE ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68132-3251
Practice Address - Country:US
Practice Address - Phone:402-553-2721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-18
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE917101YA0400X
NE1434101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)