Provider Demographics
NPI:1205873692
Name:LINES, IRENE L (LCSW,LMHP)
Entity type:Individual
Prefix:MS
First Name:IRENE
Middle Name:L
Last Name:LINES
Suffix:
Gender:F
Credentials:LCSW,LMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11330 Q ST
Mailing Address - Street 2:SUITE 222
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-3679
Mailing Address - Country:US
Mailing Address - Phone:402-212-9400
Mailing Address - Fax:402-597-2349
Practice Address - Street 1:11330 Q ST
Practice Address - Street 2:SUITE 222
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-3679
Practice Address - Country:US
Practice Address - Phone:402-212-9400
Practice Address - Fax:402-597-2349
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3035101YM0800X
NE11991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025203600Medicaid