Provider Demographics
NPI:1205156049
Name:GROOT, MICHELE CHRISTINE (PLMHP, PLADC)
Entity type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:CHRISTINE
Last Name:GROOT
Suffix:
Gender:F
Credentials:PLMHP, PLADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4406 S 178TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68135-3475
Mailing Address - Country:US
Mailing Address - Phone:402-612-3845
Mailing Address - Fax:
Practice Address - Street 1:4406 S 178TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68135-3475
Practice Address - Country:US
Practice Address - Phone:402-612-3845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-03
Last Update Date:2013-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEP-808101YA0400X
NE8899101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health