Provider Demographics
NPI:1821425299
Name:POORE, LINDSAY M
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:M
Last Name:POORE
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 1:1941 S 42ND ST STE 129
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68105-2938
Mailing Address - Country:US
Mailing Address - Phone:402-871-9979
Mailing Address - Fax:402-614-9947
Practice Address - Street 1:1941 S 42ND ST STE 129
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68105-2938
Practice Address - Country:US
Practice Address - Phone:402-871-9979
Practice Address - Fax:402-614-9947
Is Sole Proprietor?:No
Enumeration Date:2013-10-01
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025769200Medicaid