Provider Demographics
NPI:1265601827
Name:TICE, LEANN MAXINE (LMHP, LPC)
Entity type:Individual
Prefix:MRS
First Name:LEANN
Middle Name:MAXINE
Last Name:TICE
Suffix:
Gender:F
Credentials:LMHP, LPC
Other - Prefix:MS
Other - First Name:LEANN
Other - Middle Name:MAXINE
Other - Last Name:RASMUSSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHP
Mailing Address - Street 1:1919 S 40TH ST
Mailing Address - Street 2:SUITE 212
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-5243
Mailing Address - Country:US
Mailing Address - Phone:402-441-9280
Mailing Address - Fax:402-441-9279
Practice Address - Street 1:1919 S 40TH ST
Practice Address - Street 2:SUITE 212
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-5243
Practice Address - Country:US
Practice Address - Phone:402-441-9280
Practice Address - Fax:402-441-9279
Is Sole Proprietor?:No
Enumeration Date:2008-02-27
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE8555101YM0800X
NE3704101YM0800X
NE1843101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE96079OtherBLUECROSS & BLUE SHIELD
NE456304000OtherMAGELLAN MANAGED CARE
NE456304000Medicaid
NE470756369-26Medicaid
NE470774254-26Medicaid