Provider Demographics
NPI:1922871607
Name:CANTRELL, EMILY R (PLMHP)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:R
Last Name:CANTRELL
Suffix:
Gender:F
Credentials:PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1104 SAGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-4988
Mailing Address - Country:US
Mailing Address - Phone:308-380-4136
Mailing Address - Fax:
Practice Address - Street 1:3280 WOODRIDGE BLVD STE 200
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68801-7483
Practice Address - Country:US
Practice Address - Phone:308-380-4136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-03
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE13458101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health