Provider Demographics
NPI:1700891363
Name:KLASSEN, ELINOR SUE (LMHP LADC)
Entity Type:Individual
Prefix:MS
First Name:ELINOR
Middle Name:SUE
Last Name:KLASSEN
Suffix:
Gender:F
Credentials:LMHP LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 SYRACUSE AVE
Mailing Address - Street 2:#5A
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701
Mailing Address - Country:US
Mailing Address - Phone:402-644-9992
Mailing Address - Fax:
Practice Address - Street 1:200 N 34TH ST
Practice Address - Street 2:
Practice Address - City:NRFOLK
Practice Address - State:NE
Practice Address - Zip Code:68702-2315
Practice Address - Country:US
Practice Address - Phone:402-371-3044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3060101YM0800X
NE1587101YP2500X
NE745101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47083165926Medicaid
NE099282Medicare ID - Type Unspecified
NE47083165927Medicaid