Provider Demographics
NPI:1659660983
Name:LILE, MELISSA A (PLMHP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:A
Last Name:LILE
Suffix:
Gender:F
Credentials:PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 M ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68508-2246
Mailing Address - Country:US
Mailing Address - Phone:402-802-4924
Mailing Address - Fax:
Practice Address - Street 1:825 M ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68508-2246
Practice Address - Country:US
Practice Address - Phone:402-802-4924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-07
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE9439101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE96079, 99037OtherBLUE CROSS BLUE SHIELD
345680000OtherMAGELLAN
NE47075636930Medicaid