Provider Demographics
NPI:1972701647
Name:PROCTOR, ADAM N (MC, NCC, LPC, LIMHP)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:N
Last Name:PROCTOR
Suffix:
Gender:M
Credentials:MC, NCC, LPC, LIMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5600 S 59TH ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-2386
Mailing Address - Country:US
Mailing Address - Phone:402-484-0595
Mailing Address - Fax:402-484-6306
Practice Address - Street 1:5600 S 59TH ST
Practice Address - Street 2:SUITE 104
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-2386
Practice Address - Country:US
Practice Address - Phone:402-484-0595
Practice Address - Fax:402-484-6306
Is Sole Proprietor?:No
Enumeration Date:2007-07-04
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NELMHP-3150101YM0800X
NECPC-1670101YP2500X
NELIMHP-705101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47084125026Medicaid
NE10024982600Medicaid
48053OtherBLUECROSSBLUESHIELD
NE47084125026Medicaid