Provider Demographics
NPI:1881772341
Name:POP, MICHEAL MILES (LMHP)
Entity type:Individual
Prefix:MR
First Name:MICHEAL
Middle Name:MILES
Last Name:POP
Suffix:
Gender:M
Credentials:LMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 333
Mailing Address - Street 2:
Mailing Address - City:LOUP CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68853-0333
Mailing Address - Country:US
Mailing Address - Phone:308-745-0329
Mailing Address - Fax:308-745-0329
Practice Address - Street 1:329 J ST
Practice Address - Street 2:
Practice Address - City:LOUP CITY
Practice Address - State:NE
Practice Address - Zip Code:68853-8118
Practice Address - Country:US
Practice Address - Phone:308-745-0329
Practice Address - Fax:308-745-0329
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1303101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025370600Medicaid
NE85614OtherBLUE CROSS BLUE SHIELD NE
NE808338000OtherMAGELLAN -USER NAME