Provider Demographics
NPI:1881096493
Name:SHRADER, ELEANORE (LMHP, PC)
Entity type:Individual
Prefix:
First Name:ELEANORE
Middle Name:
Last Name:SHRADER
Suffix:
Gender:F
Credentials:LMHP, PC
Other - Prefix:
Other - First Name:ELEANORE
Other - Middle Name:
Other - Last Name:TARDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13460 WALSH DR
Mailing Address - Street 2:
Mailing Address - City:BOYS TOWN
Mailing Address - State:NE
Mailing Address - Zip Code:68010-7529
Mailing Address - Country:US
Mailing Address - Phone:402-498-3358
Mailing Address - Fax:402-498-3375
Practice Address - Street 1:11304 ELM ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-4733
Practice Address - Country:US
Practice Address - Phone:402-858-9607
Practice Address - Fax:402-973-9567
Is Sole Proprietor?:No
Enumeration Date:2014-09-25
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE4882101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026139700Medicaid
NE47037660631Medicaid
NE10025745300Medicaid