Provider Demographics
NPI:1598644122
Name:MUNDT WALDRON, NATALIE
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:MUNDT WALDRON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:NE
Mailing Address - Zip Code:69301-3766
Mailing Address - Country:US
Mailing Address - Phone:308-225-6167
Mailing Address - Fax:308-275-2042
Practice Address - Street 1:224 W 2ND ST
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:NE
Practice Address - Zip Code:69301-3766
Practice Address - Country:US
Practice Address - Phone:308-225-6167
Practice Address - Fax:308-275-2042
Is Sole Proprietor?:No
Enumeration Date:2025-08-28
Last Update Date:2025-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2641101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health