Provider Demographics
NPI:1700166808
Name:NORTHUP, ALLYSON GWENDOLYN (MS LMHP, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:ALLYSON
Middle Name:GWENDOLYN
Last Name:NORTHUP
Suffix:
Gender:F
Credentials:MS LMHP, LMFT
Other - Prefix:MS
Other - First Name:ALLYSON
Other - Middle Name:GWENDOLYN
Other - Last Name:BELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2900 S 70TH ST STE 160
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-3733
Mailing Address - Country:US
Mailing Address - Phone:402-432-5881
Mailing Address - Fax:402-477-8284
Practice Address - Street 1:2900 S 70TH ST STE 160
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-3733
Practice Address - Country:US
Practice Address - Phone:402-432-5881
Practice Address - Fax:402-477-8284
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-19
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE4218101YM0800X
NE150106H00000X
NE1386101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE$$$$$$$$$Medicaid