Provider Demographics
NPI:1952733594
Name:BONEBRIGHT, LORI JEAN (LADC)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:JEAN
Last Name:BONEBRIGHT
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:JEAN
Other - Last Name:MCELROY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LADC-1125
Mailing Address - Street 1:4215 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-1155
Mailing Address - Country:US
Mailing Address - Phone:402-730-8178
Mailing Address - Fax:402-742-9116
Practice Address - Street 1:3200 O ST STE 5
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-1510
Practice Address - Country:US
Practice Address - Phone:402-742-9616
Practice Address - Fax:402-742-9116
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-06
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1125101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)