Provider Demographics
NPI:1255433116
Name:PRENTICE, MELISSA DAWN (MS LMHP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:DAWN
Last Name:PRENTICE
Suffix:
Gender:F
Credentials:MS LMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 SO 16TH STREET
Mailing Address - Street 2:OFFICE B
Mailing Address - City:AURORA
Mailing Address - State:NE
Mailing Address - Zip Code:68818-3000
Mailing Address - Country:US
Mailing Address - Phone:402-694-6004
Mailing Address - Fax:402-694-6004
Practice Address - Street 1:302 SO 16TH STREET
Practice Address - Street 2:OFFICE B
Practice Address - City:AURORA
Practice Address - State:NE
Practice Address - Zip Code:68818-3000
Practice Address - Country:US
Practice Address - Phone:402-694-6004
Practice Address - Fax:402-694-6004
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1853101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE33102637326Medicaid
NE84312OtherBCBS