Provider Demographics
NPI:1710210661
Name:SEADORE, NATHAN JOEL (MA/LMHC)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:JOEL
Last Name:SEADORE
Suffix:
Gender:M
Credentials:MA/LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10845 HARNEY ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-2639
Mailing Address - Country:US
Mailing Address - Phone:402-916-9421
Mailing Address - Fax:402-999-8221
Practice Address - Street 1:10845 HARNEY ST
Practice Address - Street 2:SUITE 200
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-2639
Practice Address - Country:US
Practice Address - Phone:402-916-9421
Practice Address - Fax:402-999-8221
Is Sole Proprietor?:No
Enumeration Date:2009-09-10
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2083101YP2500X
NE4282101YM0800X
IA001280101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health