Provider Demographics
NPI:1770650251
Name:CARLSON, NANCY
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:CARLSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 683
Mailing Address - Street 2:
Mailing Address - City:HOLDREGE
Mailing Address - State:NE
Mailing Address - Zip Code:68949-0683
Mailing Address - Country:US
Mailing Address - Phone:308-995-6691
Mailing Address - Fax:308-995-6830
Practice Address - Street 1:710 BURLINGTON ST
Practice Address - Street 2:
Practice Address - City:HOLDREGE
Practice Address - State:NE
Practice Address - Zip Code:68949-2177
Practice Address - Country:US
Practice Address - Phone:308-995-6691
Practice Address - Fax:308-995-6830
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE605101YM0800X
NE538101YP2500X
NE55106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025226400Medicaid
NE85288OtherBCBS
NE97985OtherBCBS AUXILIARY