Provider Demographics
NPI:1710186382
Name:PELLA, MICHAEL DALE (LMHP)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:DALE
Last Name:PELLA
Suffix:
Gender:M
Credentials:LMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5900 S 59TH ST
Mailing Address - Street 2:STE 104
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516
Mailing Address - Country:US
Mailing Address - Phone:402-435-0557
Mailing Address - Fax:402-483-6306
Practice Address - Street 1:3600 VILLAGE DRIVE SUITE 110
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-6631
Practice Address - Country:US
Practice Address - Phone:402-875-9270
Practice Address - Fax:402-875-9272
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2075101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47084125026Medicaid
NE10024982600Medicaid
NE82592OtherBCBS